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Social Work's Contribution to Mental Health Services
Alan B. Siskind, MSW, PhD, Executive Vice President, Jewish Board of Family and Children’s Services
For the last 70 years, Social Workers have been the majority (60%) of mental health practitioners in the United States. Just in sheer numbers, Social Work’s influence has been enormous. There is, however, much more to consider in our contribution to mental health theory and the delivery of mental health services.
Framework
Social work, because of its inherent concern with social context and person-in-environment,
has provided leadership in broadening psychological, behavioral, and psychoanalytic
principles and practice. Social work has also successfully integrated
sociological, anthropological, political, and economic theories with these
psychological principles.
It is this holistic perspective and focus on environmental context that has allowed social work, more than other professions, to address multicultural issues in practice. Respect for individuals within the context of their unique psychosocial and cultural realities has lead to a unique ability, as well, to use engagement as a critical tool. Social Work’s emphasis on “staying where the client is” results in a person-centered approach that is, therefore, informed by theory and driven by the skills of engagement. This makes social work singularly suited to addressing mental health issues in New York’s richly diverse, evolving communities.
The profession’s ability to broaden and integrate theories from
other fields has increased its ability to advocate for those in need and
to influence social policies that promote sound and responsible outcomes.
Social Work has used its broad understanding of people and the impact
of the systems in which they live to change the systems themselves, wherever
appropriate and feasible. We have, for example, focused on the impact
of poverty and racism on the development of individuals, families and
groups. We are clearly far from achieving many goals related to the impact
of dysfunctional social systems on the mental health and well being of
our clients. The inherent components of Social Work theory and practice
and our will, as a profession, to use our theoretical base to achieve
effective advocacy, will drive us to continue addressing social and mental
health problems. We also have skills, as a profession, in coalition building
and networking; and these are powerful advocacy tools as well.
Our inherently broad and integrated knowledge base is often useful, as
well, in furthering management theory and applying effective management
practice.
My Social Work mental health expertise has certainly helped me understand
organizational complexity in terms of the diverse needs of those we serve
and those who provide the services. I have been able to apply individual,
group, family, and community theory, as well as management and business
knowledge, to the task of leading a large and diverse agency in complicated
times and within a quickly changing environment. Not only do we need to
allow ourselves to be influenced by good business theory and practice,
but we need to influence business as well. Business would benefit from
Social Work theory and practice so managers could better understand employees
and then make the transition from understanding employees to responding
to them in supportive and fair ways that create a healthy work environment.
The clear values and ethics of Social Work would serve the business world
as well.
Challenges Moving Forward
Despite the enormous strengths that Social Workers possess as providers
of mental health services, some of which I have noted above, we live in
complex times.
The high and increasing cost of health care has lead government and sometimes
private funders to oversimplify the causes of, and the solutions to, mental
health problems. There are no quick fixes o the mental health issues experienced
by most of us, and certainly not to the serious mental health issues affecting
a growing number of us. Whether problems, and subsequent suffering, are
caused by neurobiological constitutional factors, devastating environmental
ones or the dysfunction of our social systems, mental health is a complicated
field that requires interventions well informed by thorough assessment,
sound social and psychological theory and effective interpersonal engagement.
To be responsible, we need to find the most cost-effective interventions.
Being responsible, however, also means we have to know when suggested
interventions are a function of budget, politics or poorly tested research
rather than the hard and sophisticated (and sometimes long-term) work
needed to help people who are mentally ill, as well as the rest of us
who periodically or episodically suffer emotionally.
Technological advances in medication, advances in psycho-neurological
and psychobiological understanding and cognitive approaches have clearly
added strength to existing dynamic and social theory and have increased
our capacity enormously. Culturally competent practice with a wide array
of diverse communities has also added to the strengthening of clinical
social work practice. Despite these significant and positive advances
in our knowledge, we have not kept up with the enormous demands for our
skills. We are living in increasingly stressful times created by political
and psychological reactions to 9/11 and to quickly changing sociopolitical
and economic realities. The people we serve are increasingly impacted
by their complicated lives and social context and are experiencing increased
anxiety, depression, and vulnerability. It is no longer sufficient to
say we haven’t kept up because of inadequate resources (even if
true). We need to find ways to extend our skills through new technologies
(the websites for example), and redesign our delivery systems to ensure
adequate access to care for those who need us.
The Future
Looking toward the future of mental health service delivery in Social
Work practice means understanding where we have been. As I look back over
40 years as a Social Work administrator and mental health practitioner,
I have a strong sense that my training and experience have served my agency,
my clients and me well. Preparation for the work I have chosen was best
served by my Social Work training. If I were starting out now, knowing
that, I would add extensive administrative responsibilities to my clinical
practice. I also may have benefited from a Masters of Business Administration
or Masters of Public Administration degree in addition to my Social Work
degree, to enhance what I have learned on my job. I think, however, that
for Social Workers interested in mental health practice, there is no substitute
for learning good assessment and practice theory early, and to continuing
to learn beyond graduate school with continued experience, training, supervision
and reading.
It will be important for the Social Work mental health practitioner to
keep up with strong evidence-based research and to adjust practice biases
and interventions based on new evidence about what works and what doesn’t.
The Center for Social Work Practice (a joint program of the Columbia School
of Social Work and the Jewish Board of Family and Children’s Services)
is a successful example of ongoing commitment to developing an evidence
base for Social Work practice. It will be important, as well, not to give
up what works because of economic and political pressures. We need to
base our Social Work practice on solid research and outcomes studies that
give us the data to improve practice and advocate for resources. Given
the enormous complexity of people and the helping process, the tendency
for many of us is to want to oversimplify very complex issues. Careful
evaluation and testing of new and existing theories, and the outcome derived
by both, is increasingly important.
The future is both exciting and challenging. Our own success as a profession
in addressing mental health and other issues depends on the full and unambivalent
investment of resources and support by funders, regulators and the public.
The importance of mental health services has received increasing attention
as a result of discussions about mental health parity, the increased recognition
of the importance of mental health after 9/11 and the attention of the
media and the public to the suffering of people with mental health problems.
There appears to be growing acceptance that mental health is about all
of us, that we all exist on an emotional health continuum (which is dynamic
overtime) as we do on a physical health continuum. None of us escapes
the need for support at points in our lives. The Social Work profession,
more than any other, has developed the theories and strategies to address
these needs that all of us have, within the context of our total lives,
families and communities.
Finally, I trust we will not diminish the intellectual rigor needed in
our field, nor allow our theoretical knowledge to distance us from the
suffering of people we work with or the impact of destructive social forces.
Ultimately, it is our engagement with those we serve – a skill inherent
in all Social Work practice – that represents such an important
part of effective mental health intervention.
Acknowledgement: I am pleased to express my appreciation
to my colleagues, Jessica Fleischer, Dr. Kathleen McGlade, and Mary Pender
Greene for their contribution to this paper.