Current mental health approach in Canada is a shift from the traditional
mental health services to a community based Psychiatric rehabilitation (Steele,
et al., 2007). The guiding philosophies of community mental health
rehabilitation are empowerment, competence and recovery. This approach is a
combination of ecological and progressive system models. There are various
theoretical perspectives in the social work practice in a community mental
health rehabilitation setting such as developmental theories, personality
theories and practice theories. Generally practice theories are predominantly
used such as psychodynamic theories, cognitive-behavioural theories, humanistic
theories, and postmodern theories.
A conversion of conceptualized anti-oppressive perspective into real
life and values of practices required a connection between theory and practice
in the area of community mental health. Even though postmodern theories are
being used; the overriding perspective in the ground of mental health is a
bio-psycho-social model (Diaz-Granados et al., 2010). As an anti-oppressive
social work practitioner I have to define my theoretical understanding about
the fundamentals of anti-oppressive practice like egalitarianism and social
justice. The principles for specific practice behaviour and relationships that
minimize power imbalances and promote equity and empowerment would help me to
practice an anti-oppressive social work among mental health consumers (Larson,
2008). As Larson (2008) explains, during the psychiatric intervention, worker
needs to develop a service plan component includes treatment plan, vocational
service, peer support and life skill training in full participation with the
service user.
Jennifer Martin (2003, as
cited in Larson, 2008) suggests that anti-oppressive practice stands for social
justice and criticizes the current social relations which are promoting social
injustice especially in social work practice. Anti-oppressive practice
basically addresses power imbalance and promotes change in the power relationship.
This practice includes a self reflection, understanding of the oppressor and oppressed
and critical evaluation of entire intervention process in terms of nature of relationships
between worker and client (Larson, 2008). It also include a set of behaviours’
and /or skills of the practitioner in harmonious with specific clientele circumstances.
A clear and conscious consideration of my
social location will perhaps helps me to avoid the reproduction of ‘power over’
relationship with my clients; it also reinstate the connectedness with the
client problem. Critical self reflection includes a critique on our own
assumptions, values and believes (Hickson, 2011). As Fook & Askeland (2006) describes critical self reflection is the manifestation of critical theories and it is
the reflection through the lens of critical thinking (as cited in Hickson, 2011).
I believe that critical self reflection is an approach to personal as well as
professional practice to integrate or reintegrate and make sense of own
believes and assumptions. Progressive practice on the ground of
critical and postmodern theories are possible in various social work fields
including mental health, in spite of the dominance of medical model. Social
work profession with its theory, practice and research and with a holistic
approach needs to develop a primary alternative to mainstream mental health
approaches (Morley, 2003).
A study conducted by Arboleda-Flórez & Stuart (2012) found
that stigmatization degrades the value of people with mental illness. A social
and professional support system need to be created to support mental health
consumers and provide proper services. Anti-stigma approach needs to be
practiced in all levels of mental health services. Social workers can be a
strong partner in the initiative of anti-stigma practice and do advocacy for
equitable treatment for service users from the mental health service system as
well as from the society. Moreover social worker should be aware about own
behaviour that could reproduce stigmatization (Steele, Dewa, & Lee, 2007). Educate general public about the myth and
misconception about mental illness; also resist and protest the negative
representations. I think anti-stigma initiatives will not only help the service
users but also increase the credibility of social work profession
(Arboleda-Flórez, & Stuart, 2012).
I found
that mental health field in Canada have some dominant construction of social
work practice and limited space for progressive thoughts. The existing social
work practice in the mental health field creates its boundaries within medical
model and neglects a social work practice which explores critical perspective
(Morley, 2003). Critical social work helps people to understand the dominant
ideology discourse and relocate subjectively in to that discourse. It will
empower people to reconstruct their socially constructed identity and engage in
social change process. However, this process will possibly enable people to
challenge the existing dominant ideologies and deconstruct the social status
quo order.
As a social worker, I think it is
my responsibility to assist my clients to deconstruct the dominant discourses which
are maintaining social orders and power relations. From a critical point of
view, I understand the need for raising consciousness about structurally
oppressive factors which are influencing the use of mainstream mental health
services through my social work interventions with service users and
communities.
An equitable distribution of the mental
health service sector requires more targeted inclusionary strategies and
beneficial approaches. We must strengthen the link between need of assistance
and use of mental health services. In addition, it
is important to develop a comprehensive policy to promote the use mental health
services among those who are marginalized and in need of assistance. The
influencing factors for mental health service use and determinants are varied
in various studies; the common themes are stigmatization, lack of role in the
treatment process, power imbalance, culture and lack of knowledge about the
system. An approach with an anti-oppressive perspective can make changes in
mental health service sector. A critical approach in mental health field is
inevitable to make the field more accessible to general
public. I think multiple approaches can bring mental health as a
priority area in social policy discourse. According to Larson (2008) anti-oppressive
social work practice in mental health field faces numerous challenges. An
alternative thought from the existing dominant “marginalized and pathologies”
(p.44) model can make significant changes in service user’s life. Above all,
though this framework is truly motivating the social work professionals
especially those who are just out from the universities, the existing dominant
system in the mental health field is not supportive (Larson, 2008) thus it is
important to fill the gap between theory and practice.
Anish Alex MSW, RSW
References
Arboleda-Flórez, J., & Stuart, H. (2012). From
Sin to Science: Fighting the Stigmatization of Mental Illnesses. Canadian Journal Of Psychiatry, 57(8), 457-463.
Diaz-Granados, N., Georgiades, K., & Boyle, M.
H. (2010). Regional and Individual Influences on Use of Mental Health Services
in Canada. Canadian Journal Of Psychiatry, 55(1), 9-20.
Hickson, H. (2011), Critical reflection: reflecting
on learning to be reflective, Reflective
Practice: International and Multidisciplinary Perspectives, 12(6), 829-839.
Khandelwal, S. K., Jhingan, H. P., Ramesh, S. S.,
Gupta, R. K., & Srivastava, V. K. (2004). India mental health country
profile. International Review Of Psychiatry, 16(1/2), 126-141.
doi:10.1080/09540260310001635177
Larson, G. (2008). Anti-oppressive Practice in
Mental Health. Journal Of Progressive Human Services, 19(1), 39-54.
doi:10.1080/10428230802070223
Morley,
C. (2003). Towards critical social work practice in mental health. Journal
of Progressive Human Services, 14(1), 61–84.
Great analysis. I enjoyed it. Thanks
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