Social work

Question:

  1. A) In what ways do People with mental health needs experience discrimination and disadvantage? (Focus on the impact of factors relating to social locations such as class, gender, �race� and ethnicity).
    B) What contribution can social work make to ameliorate the impact of this discrimination and disadvantage?

Draw upon the relevant literature relating to discrimination and disadvantage and your own experience of social work practice to critically explore the key issues.

Ability to apply underpinning theoretical ideas, appropriate literature and research findings and use of relevant and up to date sources.   Awareness of contemporary social work practice, initiatives and developments. Application of a professional value base. Consideration of anti-oppressive practice, ethical issues and dilemmas.  Integration of critical reflection and analysis.

SOME RESOURCES INCLUDING WEB SITE THAT CAN COULD AID YOUR UNDERSTANDING OF THE ESSAY.

A practice guide on assessing the mental health needs of older people is available from the Social Care Institute for Excellence. It includes a section on older people from Black and minority ethnic groups: http://www.scie.org.uk/publications/practiceguides/practiceguide02/index.asp

Learning materials on Older People’s Mental Health can be accessed free here:

http://www.scie.org.uk/publications/elearning/mentalhealth/index.asp

Answer:

Title: Social work

Introduction

People with mental health needs experience discrimination and disadvantage in many ways. There are many contributions that can be done through social work in order to ameliorate the effect of this discrimination and disadvantage. This paper discusses the ways in which this discrimination and disadvantage manifests itself. In this regard, focus is on factors relating to social locations such as gender, class, race, and ethnicity. The paper also explores the possible contributions of social work in dealing with this problem. In these discussions, insights are drawn from both literature and my personal experiences.

Ethnicity, race, class, gender in relation to mental health disadvantage

For a long time, the issue of mental health has been associated with discussions on disadvantage, discrimination, and ethnicity. Although many efforts have been made to ensure that people with mental problems get as much help as possible, the same has not been true of minority ethnic populations. A case in point is the people of South Asian origin who live in the UK. The mental healthcare needs of these people have for a long time been neglected, even as mentally troubled people from majority tribes and races continue to receive sufficient attention.

Ethnicity appears to be a really problematic concept, particularly when categorizing populations (Mclean, 2010). It is also problematic when establishing an individual’s ethnicity. This same difficult appears to surface when one is assessing the extent to which the health needs of minority groups are being met. In most cases, difficulties arise because there are limited empirical or theoretical explanations for various ethnic categorizations. These difficulties continue to manifest themselves even in the issue of providing minority groups with mental health care.

Moreover, few, if any, health benefits seem to follow from ethnicity-related focus in the health sectors of many countries. In other words, the issue of ethnicity is rarely put into consideration when policymakers are facilitating the provision of healthcare services to people with mental health problems. Nevertheless, in recent times, academic interest in ethnicity has continued to grow.

Clearly, people of minority groups have tended to be neglected with regard to mental health needs. In the UK, for example, there are significant inequalities in the mental health care offered to people of minority ethnicities compared to those offered to people of majority ethnicities. Research regarding ethnicity and race has tended to focus on variations in the prevalence of diseases at the expense of issues of relative exclusion in the provision of preventative and curative care. Little is being done to address the mental health problems that have a bearing on the social and material conditions of people of minority ethnicities.

Too much focus disease manifestation across various ethnicities tends to reinforce the inequalities that exist. Moreover, institutional bias tends to reinforce the inequalities that exist with regard to the provision of health services. This is a worrying trend, particularly in a highly multi-ethnic country like the UK. In this country, the wide range of ethnicities include Asian, Indian, African, Caribbean, Irish, Chinese, among many others. Moreover, there are many ‘white’ ethnic groups, including Italians, Poles, Turkish Cypriots, and Greek Cypriots. However, in most cases, the ‘white’ ethnic groups are only conspicuous at the official level, for example, in Census data.

There are many reasons why policymakers need to be worried about discrimination and disadvantage among mentally problems of various minority ethnic groups across the UK. This position of discrimination continues to be entrenched largely because ethnicity is not considered a critical factor when mental health services are being planned for in multiethnic communities. Until very recently, policy making at the national level in mental health has paid very little attention to the specific needs of minority ethnic groups.

Yet for a long time, the nature of discrimination and disadvantage that black and minority ethnic populations have been experiencing with regard to the provision of mental health services has been recognized (Hannigan, 1999). To date, the available evidence indicates a trend towards the persistence of ethnic differences in the way mental health services are offered. If anything, the position of disadvantage among the mentally ill individuals from minority groups is getting worse (Coppock & Dunn, 2010). This is in line with several recent surveys, which confirm the widely-held fear that minority ethnic groups, particularly blacks, continue encountering major problems regarding access to mental health services that match their specific needs. On the overall, these surveys indicate that the healthcare outcomes have been persistently negative.

There is a lack of nationally coordinated actions directed at solving these problems. Appropriate actions are missing on the part of both the politicians and professionals. These stakeholders have not even been addressing the seemingly simpler matter of ethnic bias in the way mental health services are provided. This is an indication of the need for a national strategy on the provision of mental health services to black and other minority ethnic groups.

Nevertheless, some indicators portray an air of optimism. Currently, there are many efforts to bring about significant changes in the way mental health services are run. For instance, the NHS (National Health Service) has singled out mental health and earmarked it as a clinical priority (Corrigan, 2008). For instance, the National Plan for Mental Health and the National Service Framework are both now offering a set of action plans with an underpinning tenet being quality healthcare in general.

There is hope that with the acknowledgement of the critical role played by social and material conditions of mentally ill people, more efforts are going to be directed towards improving the mental health services provided to minority groups (Evans, 2000). On this basis, it is likely that the issues of ethnicity and social exclusion are going to take center stage in the reform agenda for mental health.

Inequality and discrimination in the provision of mental health services in the UK may also be attributed to institutional racism (Morgan, 2007). Racism has been institutionalized in both professional and government circles. Indeed, the Stephen Lawrence inquiry confirmed that the NHS, just like other public bodies across the UK, is institutionally racist. There is also a lack of political commitment to deal with the specific needs of minority ethnic groups. Even after the public acknowledgement of institutional racism, it remains unclear whether there will be an improvement in political commitment to deal with the ethnic inequalities in mental health service. The Lawrence inquiry recommended, among other things, that a change in policies, organizational culture, and institutional approaches is necessary in addressing the problems that minority ethnic groups experience.

I have personally experienced situations where minority ethnic groups living in West Midlands and West Yorkshire live in social deprivation as far as the provision of mental health care is concerned. In these areas, it is clear that there is a structural inequality with regard to the provision of primary services relating to mental health. During my stay in these minority-inhabited areas, I was particularly concerned about high incidences of poor health, disability, psychological distress, and lack of sufficient social support. These incidences were much higher compared to those found in areas inhabited by majority whites. This is an indication of structural, institutionalized discrimination on the basis of ethnicity and race.

Such discrimination also appears to be closely linked with social stratification (Thornicroft, 2007). The social and material conditions of people of lower social class limit them from affording quality mental healthcare simply because they are not able to pay for it. It is not surprising, therefore, that there is a relationship between social class and rates of occurrence of mental disorders. A valid argument here is that socio-economic deprivation among minority groups contributes to an increase in mental illness. Since such illnesses are not adequately addressed in these low-class minority-dominated areas, they tend to persist, thereby translating into a higher occurrence rate in comparison to areas dominated by majority whites.

In most cases, the extent of disadvantage experienced by ethnic and racial minorities tends to be underestimated because of preoccupation with variables of employment, housing, and education (Chakraborty, 2002). Nevertheless, social and material stresses contribute greatly to the prevalence of mental illness among these minorities. It should be borne in mind, though, that this situation may be moderated by such factors as community social capital and social support.

A position of disadvantage with regard to social class is normally considered an indication of discriminatory actions against minority groups (Corrigan, 2003). This is clear evident in the area of employment experience where exclusionary practices tend to work against many minority groups in the UK. In this regard, the connection between poorer mental health and social class becomes even more succinct, majorly through psychosocial and material relationships (Karlsen, 2005). In such a situation, it is not surprising that most minority ethnic groups expect discriminatory treatment whenever they go to seek public services. This phenomenon, together with the higher likelihood of harassment in the workplace, can only make an individual’s mental illness worse (Blofeld, 2003).

Regarding gender, there are subtle differences in the way men and women with mental illness experience discrimination and disadvantage in the UK (Taylor & Gunn, 1999). Meanwhile, even before one analyzes the differences in discrimination and disadvantage, it is imperative to first focus on differences in the manifestation of mental illness in men and women. For example, the recorded rate of depression in women is two times higher than in men. Moreover, two thirds of all imprisoned women suffer from a mental problem. Additionally, women are more vulnerable to risk factors relating to poor mental health than men. Other problems that affect females more than men in relation to mental illness include poverty, violence and abuse, social isolation, sexual violence, domestic violence, bereavement in old age, physical ill health, and severity of mental illness.

On the side of men, one in every eight of them suffers from a mental health problem. Moreover, 75% of all suicides in the UK are male (Bean, 2001)). Other factors that put men at a higher position of disadvantage compared to women include alcohol dependence, falling victim to violent crime, poor educational attainment, and lower access to social support. These differences between the circumstances of women and men impact significantly on the way members of the respective gender experience racism.

Contribution of social work in ameliorating the impact of this discrimination and disadvantage

Social work can make a far-reaching contribution in ameliorating the impact of ethnic, racial, class, and gender discrimination among people with mental problems. Social work is founded on the social values that are in line with humanitarianism and egalitarian ideals. It is on this basis that people engage in social work. Through social work, people are able to understand the relationship between the individual, group, and the environment in which they live. The practice domain of social work is such that it is possible to make a lasting, positive impact on mentally ill people.

In social work, a core component is the establishment of relationships and networks between individuals, such that formal structures are formed with the communities in which they live (Fernando, 2001). Social work cements the societal norms that have already been formed in the localities in which the mentally ill people live. Indeed, the focus on aspects of relationship-building is a key distinguishing factor for this profession. This collaborative approach can work out well in the field of mental health. Indeed, social workers are properly positioned to contribute significantly to the achievement of the mental health goals set in the contemporary world.

From a formal perspective mental health services in the UK are provided through the public service. However, there are many private and voluntary agencies that play crucial roles across the country. Moreover, there are many private practitioners who specialize on issues of mental health. At all these levels, social workers participate in both micro and macro levels. In this context, it is clear that the profession of social work contributes greatly to social change, empowerment, problem solving, and liberation of minority groups.

Through the use of theories of social systems and human behavior, social work can successfully intervene in all areas where people are interaction with their environment (Coppock & Hopton, 2000). Mental health constitutes a crucial ways through which people interact with their immediate environment. Mentally ill people tend to have their condition identified on the basis of their interaction with their environment. When these interactions are appreciated from a professional point of view, it becomes easy for solutions to be sought.  This is especially the case considering that the principles of social justice and human rights form a core element of social work.

At the micro level, social workers are expected to concern themselves with the wellbeing of their clients at a personal level as well as their families (Warner, 2007). In this regard, they should address their mental, spiritual, and physical wellbeing. Social work also entails engagements with mentally ill clients at the macro level. At this level, a social worker has to have the ability to see beyond the mental illness and issues of treatment, to analyze the broader social-political context in which issues of mental health are addressed (Oliver & Huxley, 1996).

It is clear that social work has continued to put new strengths into efforts to deal with mental illness in the UK (Leff, 2001). It is against this backdrop that social workers in the UK decided to support the introduction of Competency Standards for use by all the country’s social workers. These competency standards have been crucial in enabling social workers recognize the complex social context in which they have to operate when addressing mental health issues. This is particularly true of societies where class, ethnic, gender, and racial discrimination against mentally ill people is rampant.

From my personal experience, I have come to appreciate the way in which social work extends beyond focus on specific medical models to address structural issues and social inequalities. I admire the way social workers are able to maintain a dual focus as an ethical requirement. In this dual focus, they have to address a mentally ill client’s private problems on the one hand and public issues on the other.

Interestingly, the roles that are allocated to social workers are common to those that are allocated to all disciplines relating to mental health (Sayce, 2000). Social work, however, appears to tower over all these disciplines because of the additional roles of building stable partnerships among caregivers, professionals, and families (Pilgrim & Rogers, 2002). Other additional roles include collaboration with the community, advocacy on adequate service, challenging policymakers to address the problem of poverty, and supporting initiatives that dwell on preventative programs (Pilgrim, 2005). Specifically, social workers are most interested on prevention programs that emphasize early intervention, public education, and improved access to resources, services, and information.

The role of social work in ameliorating the impact of discrimination and disadvantage among mentally ill people may be summed up into three categories: prevention, treatment, and rehabilitation (Ramon, 1996). It is part of a social worker’s daily work schedule to undertake activities that touch on each one of these areas (Pilgrim & Rogers, 2005). The social workers encounter such scenarios largely because they have to encounter different clients whose personal, family, and community needs vary (Department of Health, 1999).

In prevention, the goal of social work is to ensure that there are as few incidences of mental illness as possible (Ritchie & Dick, 1994). They also endeavor to ensure that there is no social dysfunction among individuals as a result of mental illness or stressful environments. In the prevention work, social workers can endeavor to promote and maintain good health private and public education, advocacy on adequate standards with regard to basic needs, and protection against risk of mental illnesses (Coppock & Dunn, 2010). In the context of mental health, these activities may entail educating clients on emotional self-care and informing them about the need to maintain healthy relationships (Keating & Robertson, 2002). This work also entails community development efforts as well as advocacy for social justice and social action (Coppock, 2000).

In treatment, social work can entail reducing prevalence of various mental illness disorders (Reynolds & Muston, 2009). This can be done through early diagnosis and treatment. It can be really helpful for treatment activities to be directed at individuals with acute psychiatric symptoms. The attention of social workers may also be drawn to people with additional symptoms such as stress, relationships problems, emotional trauma, and distress. In this regard, the main activities in social work can include assessment, counseling, risk management, therapy, and advocacy (Langan & Lindow, 2004). It is upon social workers to determine whether counseling is best done at individual or family level. Sometimes, it may be necessary to handle counseling at the level of individual couples. In most cases, these interventions should succeed bearing in mind that in social work focus is primarily on building social relationships in problem-solving.

In my neighborhood in London, I experienced a situation where a couple was going through a stressful moment and the husband was suffering from a mental illness. The husband had just been released after completing a three-year prison sentence. His family was going through difficult financial times. Being a minority group (blacks), the family members were dealing with many problems yet they were getting few education and employment opportunities. Being a white-dominated neighborhood, not much was forthcoming by way of social support. However, through family counseling, the family managed to put its act together. Within three months of counseling, the main problem (that of the husband’s mental illness) was solved. Soon,

In rehabilitation, the main aim ought to be to reduce the impact of mental illness. Here, the best way forward in social work is advocating for re-training services for those who have recovered from mental illness. This is in line with the social goal of ensuring that the remaining capacities of the individual are maximally utilized. The aim is ideally to rebuild knowledge and skills, provide specialized vocational resources, create room for leisure activities, establish a new residential setting and advocate for a change of community attitudes.

Conclusion

In summary, there are many ways in which people with mental health needs experience discrimination and disadvantage. In ordinary cases, the manifestation of this discrimination and disadvantage has a lot to do with many factors, including gender, class, race, and ethnicity. A complex interrelationship among these factors works out to put people of minority in a situation of social disadvantage. One of the characteristics of this disadvantage and discrimination is social and institutional neglect for people with mental illness.

Fortunately, there is a lot that can be done in social work to improve the circumstances of mentally ill people who belong to minority social groups by virtue of their social class, gender, ethnicity, or race. The activities of social work that can be of the greatest help to mentally ill people entail prevention, treatment, and rehabilitation.

References

Bean, P. (2001) Mental Disorder and Community Safety, Basingstoke: Palgrave.

Blofeld, J. (2003) Independent Inquiry into the Death of David Bennett, Cambridge, Cambridgeshire Strategic Health Authority.

Chakraborty, A. (2002) Does racial discrimination cause mental illness? The British Journal of Psychiatry, 180(3), 475-477.

Coppock, A. & Dunn, B. (2010) Understanding Social Work Practice in Mental Health, London: Sage Publications.

Coppock, V. & Dunn, R. (2010) Understanding Social Work Practice in Mental Health, London: Sage

Coppock, V. & Hopton, J. (2000) Critical Perspectives in Mental health, London: Routledge.

Coppock, V. (2000) Critical Perspectives on Mental Health, London: Routledge.

Corrigan, P. (2003) An Attribution Model of Public Discrimination Towards Persons with Mental Illness, Journal of Health and Social Behavior, 44(2), 162-179.

Corrigan, P. (2008) The impact of stigma on severe mental illness, Cognitive and Behavioral Practice, 5(2), 201–222.

Department of Health (1999) National Service Framework for Mental Health: Modern Standards and Service Models, London: Department of Health.

Evans, J. (2000) Employment, social inclusion and mental health, Journal of Psychiatric and Mental Health Nursing, 7(1), 15–24.

Fernando, S. (2001) Mental Health, Race and Culture (2nd ed.) Basingstoke: Palgrave.

Hannigan, B. (1999) Mental health care in the community: An analysis of contemporary public attitudes towards, and public representations of, mental illness, Journal of Mental Health, 8(5), 431-440.

Karlsen, S. (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England, Psychological Medicine, 35(2), 1795-1803.

Keating, F. & Robertson, R. (2002) Breaking the Circles of Fear: A Review of the Relationship between Mental Health Services and African and Caribbean Communities, London: The Sainsbury Centre for Mental Health.

Langan, J. & Lindow, V. (2004) Living with risk: Mental health service user involvement in risk assessment and management, London: The Policy Press in association with JRF.

Leff, J. (2001) Why is care in the community perceived as a failure? British Journal of Psychiatry, 179(2), 381-383.

Mclean, C. (2010) African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities, Social Science & Medicine, 56(3), 657-669.

Morgan, C. (2007) Social exclusion and mental health, Conceptual and methodological review, The British Journal of Psychiatry, 191: 477-483.

Oliver, J. & Huxley, P. (1996) Quality of Life and Mental Health Services, London: Routledge.

Pilgrim, D. & Rogers, A. (2002) Mental Health and Inequality, Basingstoke: Palgrave.

Pilgrim, D. & Rogers, A. (2005) A Sociology of Mental Health & Illness (3rd Edition), London: Open University Press.

Pilgrim, D. (2005), Key Concepts in Mental Health, London: Sage.

Ramon, S. (1996) Mental Health in Europe, Basingstoke: Macmillan.

Reynolds, J., & Muston, R. (2009) Mental Health Still Matters, Basingstoke: Palgrave Macmillan.

Ritchie, J., & Dick, D. (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis, London: HMSO.

Sayce, L. (2000) From Psychiatric Patient to Citizen, Basingstoke: Macmillan.

Taylor, P. & Gunn, J. (1999) Homicides by people with mental illness: myth and reality, British Journal of Psychiatry, 174(3), 9-14.

Thornicroft, G. (2007) Stigma: ignorance, prejudice or discrimination? The British Journal of Psychiatry, 190(3), 192-193.

Warner, J. (2007) Structural stigma, institutional trust and the risk agenda in mental health policy, in Clarke, C., Maltby, T. & Kennett, P (eds) Social Policy Review 19: Analysis and Debate in Social Policy, 2007, Bristol: The Policy Press/Social Policy Association, pp 201-220.

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