Client’s Self-determination in Community Development. Anish Alex MSW

Client’s Self-determination in Community Development

     The right of making decision about a person’s own life is the cornerstone philosophy of social work profession. Client’s self-determination is defined as the capacity of an individual to make decision on their lives, actively play a vital role in the helping process and/or the right to lead a life according to their personal choices (Weick & Pope, 1988, as cited in Wong, 2000). This conviction has ascribed value to the social work profession through the official forms of code of ethics promoted by professional bodies (Furlong, 2003). In the community development sector, client self-determination is a collective right. It is the power and responsibility taken by the community for their own lives and development. It covers the perception of freedom in the socio-economic, political, cultural and the context of existence in which people live, socialize, raise families, participate in the community activities, vote, work, and relate to each other. The concept of community self-determination is the empowerment of the community to organize for social rights and justice for themselves and their peers.

     Furlong (2003) explains that even though client self-determination is the fundamental principle of the profession; well canvassed limitations are there to exercise it. When I was working as an outreach anti-poverty program coordinator for people living in poverty in a south Asian pluralistic community, I faced numerous challenges in the context of client self-determination. I had to implement various anti-poverty programs in a community which was totally different belief and value system from me in terms of religious and political ideology.  For instance, government introduced a provincial employment program as part of economic development of disadvantaged communities. The provincial government identified fifty high-risk neighbourhoods and planned to open meat processing and packing units in each community. The program was designed to support the unemployed members of the community. As I was involved in different stages of planning, I was convinced about the potential of the program to enhance the economic development of the local community within the ‘poverty pockets’ areas. I anticipated that the project would be helpful for my clients to earn good income. I was so proud to announce the project to the community with an assumption that I know their problems better and the project would be a solution for their problems. But majority in the community were reluctant to welcome the project because they believed that the meat processing and packing unit is not an appropriate place to work according to their religious belief. I became confused that the pilot projects were a success in other communities. After few weeks of indecision I realized that I should respect my client’s decision as they owned the right to decide what kind of work they want to do and how to lead their own life. I reported the decision of the community to the government.

     As a critical self reflection, I was trying to impose the mainstream social and political ideology in the form of employment program without considering the client’s capacity to determine their choice of life. I appreciate that the community possess their unique interpretations for their decision. However as Wong (2000) argued in his article it is a “moral constraint” up on workers.  Even though the community’s decision was contrary to my belief and genuine interest to support them; I should understand and respect the cultural and religious value system possessed by the community. I need to accept their decision just because it was their choice of employment (Wong, 2000).

     Moreover, my professional knowledge and the mainstream discourses about the needs of the community is not greater than the community’s unique experiences of their life situations (Wong, 2000).  As a helping professional I should constantly confront the oppressive factors which restricts the self-determination/collective right of my clients in the context of micro and macro level of practices, indeed, it will add more value in to community development interventions.  

Anti-Oppressive Social Work Practice in Mental Health (Anish Alex MSW, RSW)

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.