Social Work in Mental Health: Contexts and Theories for Practice

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Edited by: Abraham P. Francis

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    List of Illustrations

    Tables
    • 2.1 Prevalence of Psychosis and Treatment Status in Six States 31
    • 2.2 Prevalence of Depression and Treatment Status in Six States 32
    • 4.1 General Health Care System in Kerala 91
    • 6.1 Questions Suitable for Client Situations 133
    • 13.1 Utilisation of Complementary and Alternative Medicine Systems 280
    Figures
    • 1.1 Mental Health Governance 11
    • 1.2 Mental Health Facilities 14
    • 1.3 Professional Manpower 15
    • 1.4 Worldwide Expenditure on Drugs (in USD) 16
    • 6.1 Seven Key Principles of Strengths Practice 130
    • 10.1 Reconnecting with and Working Through Experience of a Significant Negative Event 210
    • 10.2 Sex-specific Bio-behavioural Responses to Stress 217
    • 12.1 General Effects of a Disaster 253
    Boxes
    • 1.1 Disability Related to Health Conditions 8
    • 1.2 Project Atlas 2001 10
    • 1.3 Messages from Mental Health Atlas 2011 10
    • 1.4 Services Delivered 14
    • 2.1 Challenges for Mental Health Care in India 31
    • 2.2 National-Level Initiatives to Address Mental Health Needs 37
    • 2.3 Objectives of the National Mental Health Programme 40
    • 2.4 Approaches to the National Mental Health Programme 40
    • 2.5 Five Strategies of the National Mental Health Programme in the 10th Five-Year Plan 41
    • 2.6 Objectives of the District Mental Health Programme 44
    • 6.1 The Objectives for Social Work Intervention in Mental Health 127
    • 6.2 Conversation between Social Worker and Client 132

    Foreword

    I am pleased to introduce this book titled Social Work in Mental Health: Contexts and Theories for Practice, edited by Abraham P. Francis, Senior Lecturer at the James Cook University in Australia. It has been quite a challenge for him to bring together a range of professionals, mostly social work educators and practitioners from Australia and India on social work practice in mental health. This book will be useful in teaching, skill development of social work practitioners and for future researches and collaborations. The chapters cover current practices, theoretical debates, social work interventions and challenges faced by the social workers in the field of mental health.

    Mental, neurological and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14 per cent of the global burden of disease is attributed to these disorders, most of the people affected—75 per cent in many low-income countries—do not have access to the treatment they need (WHO 2013). Only between 76 per cent and 85 per cent of people with severe mental disorders in low- and middle-income countries receive no treatment for their mental health conditions compared to the corresponding figures for high-income countries, which were also unenviable, that is between 35 per cent and 50 per cent (WHO 2011 and 2013).

    There is a growing recognition of the global community that countries, especially low- and middle-income countries need to pay greater attention to mental disorders and prevention of mental health problems as a large number of those can be prevented and treated. As people living with mental disorders have to suffer the dual burden of the disease and the stigma arising out of gross misconceptions, there is great need to develop appropriate interventions to change attitudes and to protect the human rights of this highly vulnerable population. Among those caretakers and health care providers, professional social workers play a major role in working with the affected individuals, their families and the community at large. Professional social work also has a very significant contribution to make in the prevention of these disorders and for the promotion of mental health.

    I am sure that this book will find a place in many of our social work educational institutions, especially in the Asia and Pacific region, and will be a good reference book for our social work students and faculty.

    Vimla V.Nadkarni, PhD, President, International Association of Schools of Social Work (IASSW) Vice-President, Bombay Association of Trained Social Workers (BATSW) Founder Dean and Professor (Retd), School of Social Work Tata Institute of Social Sciences Mumbai, India
    References
    World Health Organization. 2011. Global Burden of Mental Disorders and the Need for a Comprehensive, Coordinated Response from Health and Social Sectors at the Country Level. Report by the Secretariat. Retrieved on 14th April 2014 from http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf
    World Health Organization. 2013. WHO Mental Health Gap Action Programme (mhGAP). Retrieved 14th April 2014 from http://www.who.int/mental_health/mhgap/en

    Acknowledgements

    It is with a great sense of hope, excitement and accomplishment that I would like to present this book to the readers, especially social work students. There have been a number of people who have been instrumental in bringing this book project to fruition. I would like to first of all acknowledge the loving providence of God, who protected me and blessed me with some fantastic colleagues and friends to work on this project. Likewise, support and assistance have come from many corners for which I am indebted and grateful.

    Mental Health as a subject has always been a fascination for me. During the course of my own studies and practice I developed a passion for this subject. The greatest of all learning in this field occurred when I started working with my clients. They taught me a lot—many of which were matters that I had not learned through my formal studies. Therefore, I would like to thank all my clients and colleagues who supported me, guided me and challenged me in my clinical practice. In particular, I would like to thank all my team members at Clare Mental Health, South Australia, and very specially John Banister, our then team leader who allowed and supported me to venture into community mental health practice, and Pat Glenister for mentoring me in mental health social work. Their support has been a key inspiring aspect of my journey in editing this book.

    I would like to thank Vimla V. Nadkarni, Professor and Founder Dean, School of Social Work, Tata Institute of Social Sciences, and the President of the International Association of Schools of Social Work for writing a foreword for this book. I would like to also express my gratitude to all chapter authors for offering the readers excellent insight into social work practice within a mental health setting. I am aware that many of them were extremely busy with their teaching, research and other academic commitments, but nevertheless took out time to be a part of this wonderful project. You honour me with your participation in this project, and for that I am truly grateful.

    This book would not have been possible without the help and assistance of my students and colleagues at James Cook University. Very special thanks to S. Sharma who provided with some anecdotal evidence for this project and for being part of this work. At each step of this journey, my colleagues provided me with overwhelming support and encouragement, particularly Mark David Chong, Debra Miles, Wendi Li, Peter Jones, Nonie Harris and Ines Zuchowski.

    I am equally indebted to Professor Robert Bland, from the University of Queensland, who constantly encouraged me, provided feedback and mentored me in this project. I am likewise thankful to John Ashfield, from the Australian Institute for Male Health Studies, for his tireless support and inspiration. I also thank Professor Sanjai Bhatt from Delhi University for his support to this project.

    During the course of this project, I have been blessed to have come into contact with so many scholars hailing from different walks of life. Some have been able to contribute to this book, while others offered me words of appreciation, direction and further references. I thank them all. I would like to especially thank Professor R. Srinivasa Murthy, who graciously allowed me to reproduce his outstanding paper as a chapter in this book.

    I am also deeply touched and honoured by the support of my friends. To that end, I would like to thank my friend Kalpana Goel from the University of South Australia, for her support and excellent suggestions. Special thanks are also due to my friend and colleague Professor Ilango Ponnuswami from Mangalore University for his encouraging words, reviewing some of the chapters and for his insightful comments. My gratitude likewise goes out to my colleague Venkat Pulla, University of the Sunshine Coast, for sharing his knowledge and understanding of strengths-based social work practice and mental health issues with me. He has been a keen supporter of this project and I really thank him for all he has been to me through the various roles that he has played over this period as an author, colleague, supporter and critic. I thank Shoba Ramachandran for critically reviewing some of the chapters that came to us for this book, and doing such a good job at it.

    On the production side, I wish to thank Rekha Natarajan, Sutapa Ghosh, Supriya Das, Saima Ghaffar and Anupam Choudhury for their professional support, comments, suggestions and commitment to seeing this work published.

    As you can imagine, this has been a long but passionate journey for me and for my family. I thank my wife, Mini, for her critical questions, deep and meaningful reflections and her invaluable suggestions for the book. I also thank my children, Abhijith and Alka, for their understanding, and for patiently waiting for me to help them with their academic work and sports activities.

    Abraham P.Francis

    Prologue: The Making of the Book

    The inspiration to lead a book on social work practice in mental health did not just happen overnight. There were a couple of incidents and events that influenced my thinking and practice in the field which motivated me to take this work. Social work practice in mental health is an important area of practice. This collection deals with a variety of gaps in the literature and also provides a fresh outlook for an international audience. This book finds a niche for itself as it brings academia that are involved in interdisciplinary practice. A series of incidents has prompted me to shape this book. As a faculty member in social work some 15 years ago, I was responsible for a field placement for one of my students in a mental health hospital in India. At that time, it was not a course unit taught at the college, but a mere placement option in a psychiatric hospital setting that was made available to interested students, although subject to discussion and negotiation with the said medical facility. A number of my peers were a bit concerned about sending students to a place that represented great misery and disappointment for social workers at that time. The question then arose as to whether it would be a prudent action to place a young and naive social work student in a mental health setting that offered a difficult practice context and a grim future. I still remember that a student came bravely to express her keenness. While some of my colleagues were apprehensive about sending her into such a potentially harsh environment, the student not only received a start but finished her placement and went on to do a masters in social work. While I deeply appreciated the practical issues that many of my colleagues in the 1990s warned me about, clearly there was an ideological difference that permeated our discussions in those years. The primary issue was: Is this place suitable for an undergraduate placement? Or was there an undercurrent of resistance due to stigma attached to mental illness even in the social work field 15 years ago? I did not have a clear answer then; but this made me reflect about the role of social workers in the field of social work practice and was a key motivating factor behind the making of this book.

    Meanwhile, I was very keen to provide a safe, supportive environment for my student and an opportunity to see, grasp and fathom for herself and to experience what a gigantic task it would be to be involved with mental health issues. The student was well supported and received much appreciation from many, which not only motivated her but also later motivated other students to undertake placement in a psychiatric setting.

    I felt that mental health is everybody's business and social workers have a special role to play in this field. Thus began an impulse to write a book for new students about the role of social work in rehabilitation and/or treatment. For a long time, nearly 15 years, this remained a dream. In the meantime, another student of mine took up the cudgel and wanted to do his placement in a mental health facility, and upon successfully completing it, both these students gave me the confidence, courage and anecdotal evidence to engage in developing culturally appropriate literature and trainings for students in mental health. On reflection, these early challenges really spurred me on to develop meaningful materials that would attempt to de-stigmatise and demystify issues in mental health for my students.

    After a long hiatus, I came into contact with my first mental health placement student again in 2011. She was by then actively engaged in social work and was settled in the United States. While we were catching up, she said something to me which rekindled this idea to lead this book. This is what she had to say:

    Being a Social Work student in India was always a choice everyone questioned. It was hard for even my own family to sometimes understand what good a degree in social work could be as a career? After all these years of its presence, social work still struggles for its place in the working world as a profession. Starting a career in social work was a decision that I made not just because it was different but also because it offered learning through working. So far, pursuing a career in this field has meant a great experience for me. It has moulded me into the person that I am today and how I perceive the world around me.

    During the course of my study (Bachelor's in Social Work), there were several challenges I was faced with, but the major one arose in the final year. I was to be placed for my concurrent fieldwork at a mental health hospital. There were doubts raised by the hospital social workers that Bachelor's students lacked the experience required to make the best of the training in a mental health set-up and to make any contribution as a part of their team. Similar doubts were raised by some of my college faculty members as well, stating that Psychiatric Social Work was much too complicated for Bachelor's students, and had not been attempted before. There also was an unfounded fear within me, making me doubt my own ability to work in that place, since it was so overwhelming to see as much sadness and people dealing with all the problems they had that it almost depressed me. I felt at a personal level that I might not be able to deal with it.

    So the first hurdle in my way I had to leap over was my own mindset, and I did overcome my fear. After my first couple of visits to the hospital, I had an epiphany and realised this is what I wanted to do. I saw that all the people coming in to the clinics everyday were dealing with so much and still doing what they must despite their problems. The people I observed and I was going to work with, themselves, became my inspiration to work there. I believed that this is what I was meant to do, no matter how hard it may seem.

    Fortunately for me, our college supervisor had faith enough in my willingness to work there and my readiness to take on what everyone else thought was an oddball of a task. He discussed these issues with the college as well as the hospital's social work department and thus my training started. It was decided that for the first quarter I would only be making observations in the OPD clinics and if the hospital supervisor felt I had learnt enough by then, I could be an active participant in the team's work.

    And so it happened, the training began, I made the most of my hours of observation in various outpatient clinics, reading at the library and discussions with the doctors and gaining from the perspective of teams of all professionals and understood the role of social workers in the whole scenario. Upon completion of the first quarter I was gauged by the supervisors and was then allowed to practise at the hospital. With guidance from my supervisors and the hospital doctors I gained knowledge about various psychiatric, psychological and other mental health disorders. But most of all I learnt of the social issues surrounding mental health problems. I came to realise that till date in our country (India), mental health problems were considered a ‘taboo’. The families most of the times failed to recognise the actual problems of the patients. Even when they do find out about the problem, they do not wish to seek help for it, for the fear of being ostracised by the society. There were several patients in the rehab centre who had been brought over by their families for treatment, but never taken back by that family member, thinking of them as a liability. This display of sheer apathy on the part of family members was the most difficult to comprehend and saddening. But the reason for such behaviour was clearly the fact that our society still does not understand mental health; even something as depression is looked down upon and people refuse to see doctors for it, fearing what others might think of them. So one can safely say that the role of a social worker in the field of mental health is quite crucial especially in a country like India, where awareness needs to be brought about amongst the masses about these issues and people need to be rid of their biases and prejudices against those ailing.

    At the end of the year, my determination and my teachers’ belief in me paid off, and I completed the training successfully. Thanks to this experience and all that I learnt from it, I want to be a social worker in the field of mental health. (Personal communication with S. Sharma, 2012)

    My professional experience of working in the mental health sector has definitely influenced my thinking and I was very keen on including the consumer's voice in the subjects that I was responsible for teaching. All of these experiences, reflections and ambitions have in a way, directly or indirectly, affected my ethos and created a thirst in me for wanting to contribute to the social work fraternity. Unfortunately, it has taken almost 15 years for me to crystallise this dream into reality.

    The need for such a book was also another factor which spurred me on. This book, therefore, represents an effort to bring together various academics in this field from Australia and India to share their knowledge. There are a number of social workers born in India and employed as mental health social workers in Australia, and there are many others who aspire to provide their therapeutic expertise in this country as well. I hope that this text will intellectually scaffold these groups by facilitating greater awareness of the areas of convergence as well as the points of departure between social work theory and practice in Australia and India.

    One in four people develop some kind of mental illness at some point in their lives. But although mental illness is one of the most common health conditions worldwide, it can be one of the hardest to come to terms with. Both for those who are ill, and for those who are close to them. People suffer twice over—from the illness itself, and because they are shunned by their families, exiled from their communities and isolated by society. (Mental Health Atlas 2011)

    From this account, it is apparent that mental health problems are very common in contemporary society. The key message from the Mental Health Atlas 2011 is that the gap between what is needed for mental health care and what is available, remains very large. This gap is also replicated in social work education, especially in developing countries. It is likewise hoped that this book will be useful in teaching, enhancing practitioners’ skills and facilitating future research and collaborative endeavours among social workers in these nations. As explained by Professor Robert Bland, ‘All social workers, whether in specialist or generalist settings, need specific knowledge, skills and values to work effectively with people with mental health problems’ (Bland et al. 2009). The book is therefore aimed at: (a) students pursuing Bachelor of Social Work, Master of Social Work and MPhil in Medical and Psychiatric Social Work; (b) social work practitioners; (c) field educators; (d) researchers; and (e) social work educators. This book will orient the reader through the various local and international concepts used in mental health, the intellectual base for such practice, current practices, models, debates in the field, and challenges for social work practice. The contributors to this book have come from various backgrounds and they are from social work, psychology, psychiatry, law, criminology and education, which presents a multidisciplinary view of the current practice models. The book is also enriched by the voice of the consumers, which is also a new direction of practice. Principles of ‘social justice and human rights’ are the core values that underpin the philosophical framework of this book as social workers are called to advocate on behalf of the marginalised, under-represented and vulnerable sections of society.

    The book is divided into two parts, with each part containing a number of related chapters. The first part sets out the context of social work practice. The second part discusses the various theoretical frameworks that influence the work we do as social workers. At the end of the book, you will find two appendices. Appendix 1 explains the key terms that are used in this book and Appendix 2 provides you with a set of reflective questions that will help the reader to engage in critical reflections and help you formulate an action plan for practice.

    I present this book to you in the hope that it will be useful for your critical thinking, education and practice.

    FrancisAbraham P.
    References
    Bland, R., N.Renouf and A.Tullgren. 2009. Social Work Practice in Mental Health. Crows Nest, NSW: Allen and Unwin.
    WHO. Mental Health Atlas. 2011. ‘Transcript of the Podcast’, retrieved from http://www.who.int/mediacentre/multimedia/podcasts/2011/mental_health_17102011/en/ (accessed: 20 January 2012).

    Introduction

    Abraham P.Francis and BethTinning*

    Welcome to Social Work in Mental Health: Contexts and Theories for Practice. This book has been designed for students and practitioners of social work in Asia (especially India) and Australia. The book brings together a range of scholarly reflections on the many different roles of the social worker in the field of mental health. Mental illness is very common. One in five (20 per cent) Australians aged 16–85 experience a mental illness in any year (Black Dog Institute 2012). Similar numbers are reported around the world (WHO 2011b). Despite the numbers affected by mental illness, those experiencing it battle not only the symptoms and effects of the illness but an accompanying stigma and shame (Bland et al. 2009). A widening gap exists between the need for appropriate support and resources for those with a mental illness and their families, friends and carers, and the actual services available (WHO 2011b). As a result, social workers are likely to work with people experiencing mental health issues in almost every area of practice (Bland et al. 2009). The values and ethics underpinning the social work profession provide a unique platform from which to offer a service that is both mindful of individual challenges faced by people living with a mental illness and committed to social justice at a broader community level, to reduce the impact of stigma and isolation.

    What Is Mental Health?

    Before we go further into the text, let us explore what is understood by the term ‘mental health’ and the implications of this for social work practice. There are varying definitions of mental health, mental health problems and mental illness. These concepts are socially constructed and therefore differ between cultures, communities and periods of time (Connor-Greene 2009). The World Health Organization (WHO) conceptualises mental health within a holistic definition of health that includes ‘a state of physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO 2011a). Such a definition understands health to be in constant change as individuals responds to stressors from their own life, their community and the environment. According to WHO (2007), ‘Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’. The National Health Priority Areas Report on Mental Health Australia defined mental health as ‘the capacity of individuals and groups to interact with one another and the environment, in ways that promote subjective well-being, optimal development and the use of cognitive, affective and relational abilities’ (Australian Institute of Health and Welfare 2011).

    Mental Health Problems, Mental Illness and Mental Disorders

    Current directions in social work practice assume that a variety of social, environmental, biological and psychological factors can impact on an individual's mental health. The symptoms and behaviour that develop from deterioration in mental health may begin to interfere with the day-to-day life of the person concerned and those around them. When these symptoms or behaviour impact on a person's capacity to negotiate their world, then support, treatment and rehabilitation may be required (Australian Institute of Health and Welfare 2012).

    The terms ‘mental illness’, ‘mental health problems’ and ‘mental disorder’ are often used interchangeably. Mental health problems are generally described as problems that interrupt a person's usual social, mental and emotional capabilities and can be linked to life challenges and feelings of inability to cope. A mental health problem interferes with how a person thinks, feels and behaves, but to a lesser extent than a mental illness. Mental health problems are more common than mental illness and include the mental ill health that can be experienced temporarily as a reaction to the stresses of life. Grief and relationship difficulties are two examples. Mental health problems are less severe than mental illness and can usually be resolved with a person's own resources. However, mental health problems can progress to mental illness if not resolved.

    Mental illness is defined as a diagnosable disorder that has a set of symptoms, which can include abnormal thoughts, emotions, behaviour and relationships (WHO 2011a). Living with a mental illness can significantly interfere with a person's daily life and mental, emotional and social abilities. Therefore, according to Australian government's Department of Health and Ageing (2012) ‘a mental illness is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria. The term mental disorder is also used to refer to these health problems’.

    Current Policy and Practice Influences in Social Work Practice in Mental Health

    Before embarking on the range of theories, knowledge and skills required for practising social work in the mental health sector, it is important to understand the various influences on current responses to the idea of health and of mental health. The causes of mental illness and subsequent methods to address these are the subject of debate in the mental health sector. In Australia, policy responses to mental health have been influenced by the WHO conceptualisation of mental health and a second approach, the population health model (Australian Institute of Health and Welfare 2011).

    The population health approach emerged in the 1980s providing a theoretical framework for understanding ‘health’. This approach differed from some previous frameworks in that it proposed that health problems are caused by a complex interaction of many different factors, including biological, social, psychological, environmental and economic factors. Acknowledging the importance of a holistic understanding of well-being, the population health approach offers a suite of responses. They include promotion and prevention, early intervention and treatment of mental health problems (Tinning 2010). In addition, a population health approach emphasises the impact of disparities between social groups in the community. The effect on an individual's mental health of issues such as poverty, access to health services, age, culture and other areas of disadvantage and marginalisation are all considered in relation to mental health and well-being. Policies and practice drawing on this model seek to address these factors in addition to supporting individuals to achieve optimal health (Australian Institute of Health and Welfare 2012). Focus shifts from an individual, disease prevention approach to a response that seeks to address the underlying influences on health. These include ideas like building healthy public policy, creation of supportive environments, facilitating and strengthening community action and participation (Australian Institute of Health and Welfare 2012).

    It is easy to see the links between this approach and the values of the social work profession. The population health approach sees equity in health status as an important goal and includes the promotion of mental health and the prevention of mental health problems and mental disorders. Social justice and human rights underpin the perception that health can be attributed to so much more than individual pathology. World Health Organization strategies, including the Ottawa Charter and the Jakarta Declaration build into prevention responses the importance of permanent housing, regular income, and provision of universal education and empowerment of the community.

    Whilst the population health approach underpins Australia's policy response to mental health and mental illness, two perspectives of health that hold influence in some services are the medical model and the sociological model. These models are rarely found in an ‘absolute’ form; most services or organisations will perceive their response to mental health as fitting somewhere on a continuum between a ‘medical’ and a ‘sociological’ understanding of mental health or mental illness (Tinning 2010).

    The Medical Model and the Sociological Model of Health

    A medical model sees ‘health’ as a state that is ‘free of disease’. It is defined by the absence of an illness, that is, a biochemical change in the individual affecting the body or mind. Mental illness therefore arises from an organic problem, located within the individual and requiring appropriate assessment, diagnosis and treatment. The medical model is most noticeable amongst responses from doctors, psychiatrists and psychologists within traditional health and mental health systems (Meadows et al. 2012).

    In contrast, a sociological model of health relates to more than simply an absence of illness. Being ‘healthy’ is seen as a state of well-being where one is physically, emotionally, spiritually and culturally comfortable. This model recognises contribution of social factors to health and ill health, including poverty, power, access and safety (Meadows et al. 2012). This model fits well within the population health approach. Sociological models, including sociocultural theories, have significantly influenced social work practices in Australia and are acknowledged in both the AASW Code of Ethics (2010) and the AASW Competency Standards for Mental Health Social Workers (2008). The consideration of how context impacts mental health allows the social worker to identify local, regional and statewide constraints and barriers that impinge on individuals, families and communities.

    A Bio-Psycho-Social Model

    The bio-psycho-social model is the preferred term used by many Australian mental health services today when describing the theoretical underpinning of practice responses (Tinning 2010: 12). Essentially, this model places itself in the middle of the continuum between a biomedical model and a sociological model of health. Organisations such as the Mental Illness Fellowship (with branches found across Australia) acknowledge the usefulness of understanding the biological underpinnings of many mental illnesses whilst also considering the social and cultural factors that contribute to mental health and mental illness. This particular model seeks to develop partnerships across multidisciplinary teams to provide a case management approach to medication, social support, counselling and advocacy. Again, this is a model of health that is congruent with many of the values and ethics of social work (Tinning 2010).

    At the end of the day, our commitment as social workers includes placing the ‘client’ (or consumer or person you work with) at the centre of your practice. It may be that medication and support regarding a particular chemical imbalance is the treatment option that works best for them, as assessed by them when they are feeling well enough to make that call. Provided medical support is included in strategies that also acknowledge the effects of issues such as gender, culture, violence, age, poverty and grief, this is congruent to social work practice. In recent times there has been discussion regarding participatory practices in mental health, including consumer-run services, based on consumer perspectives. This model assumes that the consumer group has a specific body of knowledge about mental illness, treatment and support services (Our Consumer Place 2011). Bland et al. (2009: 17) emphasise ‘valuing the lived experience’ of the person with the mental illness. Stacey and Herron (2002) argue that the process of engagement, dialogue and liaison with consumers; advocating and facilitating active involvement; and an understanding of partnership accountability are key elements to implementing effective and respectful consumer participation in mental health services.

    It is important to remind social workers of the value of a working knowledge of the principles, values and terminology used in the medical model. Given that many of the mental health systems are heavily influenced by the biomedical philosophy, social workers may require the information in order to offer advocacy, information and referral. In addition, you may find yourself working as part of a multidisciplinary team where medical terms are part of everyday use. This book will not offer you any detailed discussion on the diagnosis, treatment and follow up; rather it will provide you with various frameworks and practice experiences which are shared by scholars from both India and Australia, with a strong focus on social work practice in mental health. Current mental health practice occurs in a multidisciplinary context, and hence this book has incorporated views from psychiatrists, psychologists and practitioners, academics and legal advisors which provide a holistic picture on the topic under discussion.

    Social workers have traditionally been assumed to take a back seat in the assessment and treatment of mental illness. The role of disciplines more closely aligned with medical models of practice, such as psychology, nursing and occupational therapy, are more commonly associated with mental health practice (Parker 2010). Yet the fundamental value base and skill development of social workers has proved to be important in responding to calls for mental illness prevention, care and management for individuals and communities. Regardless of where social workers can be found, whether in government or non-governmental organisations (NGOs), in therapeutic settings or community development projects, it is likely the workers will be engaging with consumers of mental health services and their carers (Bland et al. 2009). Social workers are often found responding to the needs of those the system has left behind, providing linking for housing, income support, responding to interpersonal violence and the effects of stigma. Because of this, the editor of this book believes that no course of social work education would be complete without a broad overview of how social work engages in the field of mental health.

    This book is a compilation of practice wisdom and academic research from India and Australia. Each chapter concludes with a series of questions to guide your understanding of the content. You may choose to read from start to finish or dip in and out of various chapters or sections, depending on where your interests lie. Whatever your preferred style, the editor hopes that the text provides you with information, inspiration and enthusiasm for social work practice in the field of mental health.

    Social Work and Mental Health

    Social work and mental health practice in many countries including India and Australia is shaped by many factors, both local and international. In both countries, understandings of the nature of mental illness and the evidence-based treatments for these, can be seen as relatively constant international determinants of mental health care. Both countries share a common heritage of modern Western medicine that finds expression in similar diagnostic categories and treatments. There is a regular exchange of skilled personnel between the two countries and Indian psychiatrists, nurses and social workers are employed within the Australian mental health system. Within Australia, and possibly in India, there have been some regional differences across the country derived from differing approaches to social work education that have occurred from University to University. Social work has always emphasized the importance of social context in understanding not just the way the individual experiences mental illness, but as a site for intervention to support treatment goals. The differences in culture within India, and between India and Australia mean that the social context in which illness is experienced and treated will vary significantly, and the way that social work is practiced in these different cultural contexts will also vary.

    In Australia, defining the specific domain of social work in mental health was a major task of the Australian Association of Social Workers (AASW) project The Development of Competency Standards for Mental Health Social Workers (AASW 2008). It is this definition of domain that has been largely adopted in the Australian social work and mental health literature. It may be useful to quote this definition in some detail.

    The domain of social work in mental health is that of the social context and the social consequences of mental illness. The purpose of practice is to restore individual, family, and community well-being, to promote the development of each individual's power and control over their lives, and to promote principles of social justice. Social work practice occurs at the interface between the individual and the environment: social work activity begins with the individual, and extends to the contexts of family, social networks, community and the broader society. (AASW 2008: 21)

    What Social Workers Do?

    While there is still a lot of debate about what social workers do in mental health field, the social workers’ contribution to mental health is recognised and accepted as a legitimate field of practice.

    Social work and social workers are important. Social work makes an important contribution to mental health services and is a crucial component in their development.…However, like any other profession, social workers cannot afford to rest on their laurels and stand still. If they do, they will get behind. In an increasingly rapidly changing world of new demands and pressures, where there is a need for a more flexible and well-trained workforce, it is vital that social workers fully embrace this culture shift and seize fresh opportunities, including new ways of working. This does not mean they should abandon their highly prized and well-recognised value base. Far from it, they should continue to champion both their approach and their cause, but should do so in a positive and outward-looking way. (Department of Health 2007b: 117, cited in Gould 2010: 181)

    There is a demand for production of relevant knowledge pertaining to strengths-based approach that can be used in social work. The research focus in the future should endeavour to take up initiatives to develop social work research capacities in mental health field, especially from a strengths perspective which will contribute to the increased level of knowledge base and confidence among social work practitioners in the field.

    Thyer and Wodarski (2007, cited in Bland et al. 2009: 41) have strongly argued for positioning of an evidence-based practice model as central and professional contribution to social work research and practice. Social workers, they state, ‘have a professional obligation to promote evidence-based practice’. Similarly the ‘recovery model’ has emerged as a consistent unifying principle in contemporary mental health policies and services (Bland et al. 2009: 43). Although there are a number of challenges for social workers practising in multidisciplinary environments, there is an increased emphasis now placed on the profession to be engaged in evidence-based practice (Gould 2010). Research in mental health has tended to focus more on experimental research designs. However, a survey conducted by Gould et al. (2007: 180) found that ‘there is a significant level of interest in social research in mental health across a range of constituencies including professionals in both social care and health sectors and among service users’. Some of the areas identified through this survey were the emergent consensus across a wide cross section of interests. Social inclusion, social capital, social networks and social factors that enable resilience and recovery were the highest priority for topics for research. This actually resonates with some of the ideas and theme of this book to engage in future research and develop appropriate practice guides for social work practice.

    Social contexts are very important for social workers. Bland et al. (2009) point out that at the level of ‘social context’, social work is concerned with the way each individual's social environment shapes the experience of mental illness. Relevant concepts here include individual personality, vulnerability and resilience, family functioning, strengths and stressors, support networks, culture, community, class and gender (Bland et al. 2009: 10). Accountability is considered as the central theme for contemporary social work practice (Gray and Zide 2011: 1). When working with mental health clients, we are often confronted with the issue of compliance, commitment and accountability. Similarly, the concepts like relationships, consumer perspectives, participation, and accepting the centrality of the lived experience of mental illness have all got some social work practice implications.

    Social work is shaped by the context in which it is practised. As a profession, social work also has moved from charity and welfare models to a professional approach based on the value of the individual and the negotiations of social structures and relationships as a core part of its purpose (Bisman 2003, cited in Bogg 2010: 27; Brandon et al. 1995). Today, we can see more emphasis is laid on the collection of and reflection on evidence in social work practice in general. A review of literature on the historical development of treatment for mental illness demonstrates that societal views have had a significant impact on the way those experiencing mental distress were treated. The contemporary understanding and evidence suggest that there is increasing emphasis on user involvement and participation in their care (Bland et al. 2009). The recovery model is now widely embraced as an approach to practice.

    It is also a responsibility of the social work practitioner to bring particular focus upon psychosocial assessment and its importance in psychiatric and medical symptomatology, through advocacy and representations, in ensuring quality outcomes for clients (O'Neal 2003) and maintain representation at the interface between the individual and the environment in which they operate (Bland and Renouf 2001). In essence, through knowledge and learning, collaborative and reflective practice, maintenance of a sociological perspective, and adherence to social work purpose of reducing barriers, expanding choices, elimination of violations, advocacy, a commitment to increasing well-being, self-fulfilment and self-determination, celebration of difference and an overall demonstrable commitment to developing individual and community competence, one is fulfilling the obligations, role and purpose as an effective social worker.

    The chapters in this book introduce readers to the big-picture issues of social work and mental health practice in India and Australia.

    The Social Work Role in Responding to Mental Health

    As noted, social work is a discipline practised in countries across the globe. A uniting feature of social work practice is the commitment to human rights and social justice and a commitment to addressing the impact of broader structures and discourses of power on the ‘problems’ experienced by individuals (Lyngstad 2012). It is not enough for a social worker to simply focus on the individual or family that may be accessing the service we work for. The social work code of ethics across the world urges practitioners to find strategies to both identify and make visible how power and inequality impact on people's lives (AASW 2010a; Hall 2009).

    Social workers can be found in services working explicitly with people diagnosed with a mental illness and their families and carers. Social workers can also be found in a range of other areas of practice not explicitly responding to mental illness but needing to provide a thoughtful, respectful and inclusive response to those accessing the service and living with a mental illness. Mental illness can lead to specific challenges in day-to-day living (Gould et al. 2007). A person living with a mental illness is at risk of experiencing difficulties in securing permanent accommodation, income support, and stable, safe and respectful relationships. This is a reflection of the broader community rather than the individual with an illness. It seems we are yet to develop a compassionate, inclusive and supportive environment for people diagnosed with a mental illness.

    With this in mind, the text begins with an exploration of the context of social work practice. You, the reader, are offered the opportunity to consider global perspectives on mental health, from the dominant ideologies in both Asian countries and western countries. Globalisation has transformed many aspects of society over the past 20 years and social work practice has not been immune to this. Technology and communication systems have enabled social workers from different continents to share practice knowledge and wisdom more freely and in many more formats than could have been imagined just 30 years ago (Bhat and Rather 2012; Dominelli 2010). Part 1 provides reflections on how social workers in both India and Australia have engaged with mental health, as practitioners in specific mental health services and in more generic practice. This offers the chance for you, the reader, to reflect on the settings in which you hope to work, the dominant ideas influencing practice in your location, and the impact of these on service users or consumers of mental health services.

    What Social Work Offers to Mental Health Practice

    Social work practice draws on a broad body of knowledge that includes theory from the disciplines of sociology, anthropology and psychology in addition to scholarly literature and debate from local and international social workers (Healy 2005). Social work knowledge has also been influenced by actual practice experience, with respect and recognition given to the individuals, families and communities with which social workers engage. The rise of structuralist, critical and postmodernist theories and their influence on social work practice have opened up different ways of perceiving and interacting with consumers of mental health services (Connolly and Harms 2011). The concepts applied broadly across community development and activism in countries such as India, including meaningful participation and the idea of ‘working with’ rather than ‘doing to’, has influenced policy direction in mental health in countries such as Australia and New Zealand (Bland et al. 2009; Gilbert and Stickley 2012; Repper and Watson 2012). An understanding of the knowledge that guides social work practice is important for anyone working in the field of mental health. Just as doctors, psychiatrists, nurses and psychologists can articulate their professional identity, so too should social workers be able to do this.

    In part 2, the text explores the role of theory in social work practice. A fundamental aspect of social work ‘helping’, it is argued, is the foundation of theory that guides the practitioner. Theoretical frameworks provide a ‘road map’ to explain how one understands a particular ‘problem’, the possible solutions to the problem and strategies to respond, and keep core values of social justice and human rights in the centre of practice (Howe 2009). Part 2 provides the reader with insight into important directions for social work practice. The role of recovery theory, integrative medicine and positive psychology are considered from an Australian context. South Asians and mental health are discussed, as is the role of social work in the criminal justice sector. This section has included a discussion on disasters and mental health and provides some important key points for reflections about the gendered implication for all social work practice. This section allows the student and experienced workers to consider the various theories they are drawn to, the alignment of these with professional values and ethics, and skills the worker will be required to develop.

    Areas of Social Work Practice

    One of the most inviting reasons to study social work is that the degree opens so many opportunities to work in fields as varied as community work, industrial social work, hospital work, criminal justice, the health system, poverty eradication programmes and services responding to violence. Social work responses to mental health and mental illness can be found across a diverse range of areas. This book will explore some specific needs for particular community groups including children, young people, and older people. Throughout this book, the readers are introduced to a number of thought-provoking conversations on various aspects of both theory and practice in mental health through literature.

    Where to from Here?

    Strengths-based social work practice is gaining a lot of interest among both practitioners and academics (Francis 2012). Social workers acknowledge that people with mental illness face many difficult situations and challenges on their journey towards recovery. They are very often confronted with the issue of diagnosis itself and sometimes the overemphasis on the use of DSM IV/V in practice settings. On the contrary, in strengths-based practice, we look at a person's abilities, talents, possibilities, hopes and competencies. In this approach, the social work practitioner assumes that strengths can be found in all environments, no matter how difficult they might seem (Rapp and Goscha 2006). Are we ready to embrace such a philosophical shift in our thinking and practice? If mental health is everybody's business, what is the role of communities, and how can we engage with communities so that the issues of stigma associated with mental health be addressed, thus creating an inclusive society? These are questions still unanswered. Saleebey (2009) points out that clients learn something tangible and also valuable about themselves when they struggle with difficulty as they move through life. In this process, it is important that we look at the strengths that will be useful for the person who is struggling with a mental illness and the social worker's ability to focus on the resourcefulness of a person which is a beginning step in restoring hope (Saleebey 2009). In assessing clients and in formulating a plan for action, the diagnosis does not become the centre of his/her identity; rather their strengths, resourcefulness and coping become a part of the assessment process. It is an attempt to get the ‘whole story’ of the person and acknowledge the positive energy that they may have gained through the struggles. Strengths-based practice is an approach to shift the lens away from the defining pathology and move forward with a holistic approach. This focus placed on people's strengths ‘has constituted an important paradigm shift in social work’ (Trevithick 2012: 351). ‘A strengths perspective, as opposed to a deficit model, can put individuals in touch with the more resilient characteristics that they may have lost touch with. This perspective is consistent with anti-oppressive, empowerment, culturally sensitive and emancipatory approaches within social work because the work is built on the service users’ interpretation of events and the importance of validating the meaning they give to experience’ (Houston 2010, cited in Trevithick 2012: 351).

    According to Reichert (2006), social and human service workers have a responsibility to promote the welfare of society and advocate for economic and social conditions conducive to the fulfilment of basic human needs. Ife (2008: 4) challenges the social worker to look through the lens of human rights and what this might mean to strengthening practice and achieving ‘social justice goals, in whatever setting’. This is not an idealistic concept but one that social workers have indeed used in many settings without really naming the concept behind the actions. Ife (2008: 187) points to this fact when he alludes to the very nature of action and changing our world view from a singular concept to that of human rights perspective. Similar thoughts are reflected in the literature from India as well but with a focus on community responses. Srinivasa Murthy (2011) has argued for community-level mental health services where he advocates for two activities that are required to address the needs of the community. ‘First, systematic studies are needed to evaluate the community intervention initiatives for mental health and the second is the setting up of community-level facilities, largely by voluntary organisations’ (Srinivasa Murthy 2011: 103).

    The final part of the text allows the reader to consider where social work practice is headed in future years. The hopes, intentions, challenges and directions are considered by leading authors from India and Australia. The vision of the editor is that those who read the text today, whether students, practitioners, field educators or academics, will be inspired to contribute to this exciting field of practice. Social work offers much to mental health practice. In addition, there is much that social workers can learn from our client group and other disciplines. With this idea in mind, please sit back and enjoy the chapters that follow.

    * This book is conceived and edited by Abraham P. Francis. He has had extensive discussions with the authors of this book at every stage of the production. It is a work that has involved many authors from various backgrounds, professional disciplines, professional backgrounds and countries. The focus of the book is about social work practice and mental health. The ideas, concepts and practice frame works discussed in this book are useful in any social context, but with a caution that it needs to be adapted with cultural sensitivity and appropriate level of consultation/guidance with supervisors while engaging in clinical/community practice. The effort of the editor of this book has been to orient the students or practitioners to the current areas of practice in mental health and provide a common platform for further reflection and action in their respective field of practice. The editor is responsible for the ideological framework, identifying the authors for this book and providing an overall structure and presentation of this book, while the individual author/authors are responsible for the key ideas presented in their respective chapters. Some of the chapters are based on research studies and others are views, experiences and reflections of the authors engaged in this field of research and professional practice.

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  • Appendix 1: Glossary

    The following are some of the key terms used in this text. The authors have provided some explanations for these terms. They are to be understood in the context of the chapter.

    Global Mental Health: The term global mental health refers to an international perspective on various aspects of mental health. In more simple terms, this is an area of study and research and practice that places priority on improving mental health and achieving millennium development goals’ benchmarks in many countries and accord social justice and equity in mental health programmes across all nations. Culture plays a significant difference in measurement of the achievements and likewise culture-specific and -sensitive interventions are required in treatment options, mental health education, governance and fiscal aspects, the structure of mental health care systems, human resources in mental health and human rights issues, among others.

    Mental Health: A state of well-being whereby individuals recognise their abilities, are able to cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their communities.

    Mental Health Action Plan 2013–2020: WHO's comprehensive mental health action plan 2013–2020 has now been adopted by the 66th World Health Assembly. The action plan is the outcome of extensive global and regional consultations over the last year with a broad array of stakeholders including: 135 Member States; 60 WHO CCs and other academic centres; 76 NGOs and 17 other stakeholders and experts. The four major objectives of the action plan are to:

    • strengthen effective leadership and governance for mental health;
    • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
    • implement strategies for promotion and prevention in mental health;
    • strengthen information systems, evidence and research for mental health.

    Mental Health Social Workers: Accredited mental health social workers are required throughout the world that hold a breadth of experience in assessing and treating people who have mental health disorders, such as depression and other mood disorders; anxiety disorders; personality disorders; psychosis; suicidal thoughts; relationship problems; life crises; adjustment issues; trauma and family conflicts. For example, in Australia it is important for a social work practitioner to be accredited in his or her field, especially in mental health.

    Accredited mental health social workers help individuals to resolve their presenting psychological problems, the associated social and other environmental problems and improve their quality of life. This may involve family as well as individual counselling, and group therapy. Social workers recognise the broader implications of an individual having a mental illness and the impact on friends, family, work and education. Like other allied health professionals, such as psychologists, accredited mental health social workers use a range of interventions in helping people with mental health disorders, including the following focused psychological strategies such as behavioural interventions, relaxation strategies, problem-solving, strengths-based and solutions-focused therapies.

    Social Work Practice: Service to the sick and needful people has been a part of the Indian tradition, but professional social work practice and education started much later in India. It's an account of last seven and half decades. Social work practice emerged in various fields and settings, mental health field being one of them.

    Social Work Practice in Mental Health: Social workers with its humanitarian approach help in relieving the stress of the person with mental illness. Social work as a profession not only pays attention to the persons with mental illness but also takes care of their family members and the community where they live in. After the great revolution in mental health, that is, community mental health, the role and scope of social work in mental health has widened. It is now an integral part of multi-disciplinary mental health care.

    District Mental Health Programme (India): Launched under the National Mental Health Programme during 1996–1997 in four districts and at present operational in 125 districts. The Government of India envisages the extension of the District Mental Health Programme to all the 625 districts of the country.

    Mental Health in India: Refers to a wide range of activities directly or indirectly related to the mental well-being in India, such as promotion of well-being, prevention of mental disorders and the treatment and rehabilitation of people affected by mental disorders. There are various stages of development of mental health in India.

    National Mental Health Programme (India): Developed in 1982. The Central Council of Health and Family Welfare recommended its implementation all over the country. The main objective of the programme is to ensure the availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of society.

    Kerala State Mental Health Authority: Statutory body constituted under the Government of Kerala (in India) to look after the mental health needs of the state.

    Mental Health Care: Any service or care or support provided by government, private or co-operative sectors to the mental health well-being of people in the community. It includes community-based mental health services and institution-based services.

    NGO: Non-governmental organisations with legal sanctity or registration, functioning in the field of clinical social work, especially in mental health care.

    Partnership in Mental Health Care: Collaborative efforts of the government, private and welfare/voluntary sectors in the accomplishments of the mental health care needs of the people.

    Psychiatric Social Work: Professional social work practice in mental health care setting, including, hospitals, clinics, NGOs and community psychiatric settings.

    Hope: In recovery theory, hope is that personal quality that allows a person to expect that things will get better. It is about the belief and feeling that present distress can be endured and overcome in a better future. It is action oriented. Hope is not wishful thinking, but a deeply held belief that change is possible.

    Lived Experience: Lived experience is that unique, personal experience of becoming ill, receiving treatment and finding a way through the illness. Lived experience includes both symptoms and treatment, but extends to the consequences of mental illness such as poverty and isolation, powerlessness, stigma and discrimination. It includes the positive dimensions of recovery such as supportive relationships, growing sense of agency, self-esteem and hope.

    Mental Health: Mental health is defined as the capacity of individuals and groups to interact with one another and the environment, in ways that promote subjective well-being, optimal development and the use of cognitive, affective and relational abilities (Commonwealth Department of Health and Aged Care Australian Institute of Health and Welfare 1999).

    Mental Illness: Mental illness is defined as a clinically diagnosable disorder that significantly interferes with an individual's cognitive, emotional or social abilities. The diagnosis of mental illness is generally made according to the classification systems of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) (Commonwealth of Australia 2009).

    Recovery: Recovery is a way of living a satisfying, hopeful and contributing life even with the limitations caused by mental illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.

    Strengths-based Practitioners premise that all people, families and communities have strengths, resources, capacities and capabilities and that their expertise on their own lives and situations must be put to creative use in finding means to presenting concerns and issues. Strengths-based practitioners believe that all people are capable of change and growth and that change ‘C’ is more likely when conditions are created to encourage it. The language facilitators used and the questions they ask the clients ought to be framed positively in order that clients have a chance to grow and change. The idea is to ask clients what sort of things and solutions worked in the past and then to build on them to move into the future. One of the major considerations in strengths-based practice is to create an ambiance that allows people's needs, responses, hopes, dreams and aspirations to surface. Strengths-based practitioners ought to be respectfully transparent about the power they have and use it as a resource.

    Resilience: In most simple terms ‘resilience’ refers to the notion of an individual's predisposition to cope with stress and adversity. This coping may result in the individual ‘bouncing back’ to a previous state of normal functioning, or simply not showing negative effects. Resilience crops up in situations of adversity and risk and negative life circumstances that are known to lead to poor outcomes. There are several theories and approaches that seek to address and promote resilience. Current research suggests that interventions need to address both individual and environmental factors. Such an approach allows for a holistic multi-systemic approach to support all ages and all situations.

    While individualised interventions seek to strengthen a person in resisting and persisting through adversity, sometimes an individual may also require appropriate behavioural changes in combination with interventions to affect his or her immediate social environment. Similar views are expressed in resilience literature that support multi-systemic, strengths-based understanding of family resilience and interventions that reign in the frontier of social and social cultural ecology.

    Asian: Individuals of Indian, Pakistani or Bangladeshi origin, and their descendants. The term hides the internal diversities of languages, cultures, traditions, religions, national origins and class between the different Asian groups.

    Culture: A way of life, such as family life, patterns of behaviour and belief, and languages. Cultures are not static. The idea of a stable, bounded and territorially specific culture has been transformed into a conception of culture as fluid, complex and transnational.

    Eurocentric Standards: Eurocentric standards of mental health are based on the philosophies, values and mores of Euro-American culture, and these variables are used to develop normative standards of mental health. What constitutes sane or insane behaviour, mental health or mental illness, or normal or abnormal behaviour is, therefore, always in relation to a Euro-American normative standard.

    Racism: Racism results from ‘the transformation of “race” prejudice and/or ethnocentrism through the exercise of power against a “racial” group defined as inferior, by individuals and institutions with the intentional or unintentional support of the entire culture’ (Jones 1981: 28).

    Anxiety Disorders: Mental disorders in which the person experiences anxiousness to a debilitating degree.

    Depressive Disorders: Associated with the following symptoms: depressed mood, diminished interest or pleasure in all activities, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue and loss of energy, feelings of worthlessness or excessive guilt, inability to concentrate or act decisively, decreased appetite with weight loss and recurrent thoughts of death or suicide.

    Positive Psychology: Focuses on the positive dimensions of human experience and behaviour, including how people survive in the face of adversity, and how people engage with everyday situations that foster growth and potential.

    Post-traumatic Growth: Positive psychological change experienced as a result of the struggle with highly challenging life circumstances.

    Post-traumatic Stress Disorder: The development of characteristic symptoms following exposure to an extreme traumatic stressor.

    Refugee: An internationally accepted legal term to describe someone needing protection from another country because they are being targeted by authorities or other groups involved in organised, violent campaigns in their own country.

    Resilience: A class of phenomena characterised by good outcomes in spite of serious threats to adaptation or development. It is through resilience that people are able to maintain, recover and improve in mental or physical health following challenges.

    Criminal Justice, Correctional or Forensic Social Work: ‘Social work as performed in the various criminal (and juvenile) justice systems’ (Wilson, 2010: 1).

    Mental Disorder: ‘The existence of a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions’ (ABS 2008: 94).

    Mental Illness: ‘Clinically diagnosable disorder that significantly interferes with an individual's cognitive, emotional or social abilities’ (ABS 2008: 4) and would include, for example, a whole range of short- or long-term anxiety, affective (or mood) and substance-use disorders.

    Primary Victimisation: An initial act of victimisation inflicted upon the victim by the offender.

    Secondary Victimisation or Revictimisation: Subsequent acts of victimisation unintentionally inflicted upon the victim by the criminal justice system (Herman 1992, as cited in Herman 2003: 159).

    Bio-behavioural: The application of biological methods and ideas to the study of human behaviour, in an attempt to understand emotional and behavioural responses in terms of brain and physiological functions.

    Coping: The human endeavour—cognitive, physiological, emotional and behavioural—to manage, adapt to, or survive environmental, social and personal demands of life.

    Demasculinise: An endeavour to disparage, diminish or eliminate masculine traits and behaviours, because they are believed to be problematic or inferior to those of females.

    Determinism: The idea that certain results or events are inevitable consequences of particular causes. Often understood to override personal agency, choice or free will.

    Feminise: An endeavour to make males more like females in their gender characteristics, because masculine gender characteristics are believed to be inferior to or less desirable than those of females.

    Gender: Certain generally occurring aptitudes, capacities and behaviours that are characteristically associated with men as distinct from women, or women as distinct from men.

    Ideology: A way of thinking to which a person or group subscribes, which is more based on a speculative and reductionist way of thinking than one informed by evidence or facts. Such a way of thinking is often adhered to despite available disconfirming evidence to the contrary.

    Instrumental: Serving or acting as a means or aid.

    Physiology: Branch of the biological sciences dealing with the functioning of organisms.

    Rumination: The tendency to repetitively focus on and be preoccupied with certain thoughts, impressions, emotions and experiences. Or replaying negative emotional experiences, and their possible meanings and consequences.

    Social Constructionism: A view of male and female gender which emphasises a form of cultural determinism. That cultural and social conditioning determine gender almost exclusive of the influences of human physiology.

    Suppression: A partly conscious choice not to indulge a particular thought, feeling or memory (in contrast to repression, which is a more unconscious process of forgetting).

    Gender: The socially constructed and culturally ascribed roles between men and women, biological attributes of being male or female. Refers to behaviours, activities and attributes that a given society considers appropriate for men and women. Linked with power differentials between women and men seen in most societies, as a consequence of the different expectations for the roles of men and women.

    Feminism: A set of ideas and practices aimed at defining, establishing and defending equal political, economic and social rights for women. Feminism aims to understand the nature of gender inequality by examining women's social roles and lived experiences, and ways to respond to address social and structural inequalities that women face.

    Hegemony: Political or cultural dominance, or authority, over others. Involves the process of normalisation of political dominance where there is a generalisation of dominant interests over the minority as the common interest. Dominance and subordination are exercised in such a way that the social divisions involved are naturalised.

    Mental Health: The capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice, and the attainment and preservation of conditions of fundamental equality.

    Disaster: A catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or man-made causes, or by accident or negligence, which results in substantial loss of life or human suffering, or damage to and destruction of property, or damage to or degradation of environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area.

    Impact: The effect or influence of disaster on the affected area.

    Mental Health and Psychosocial Support: A composite term used to describe any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorders. It is also used to describe non-biological interventions for people with mental disorders.

    Vulnerability: The degree to which a socio-economic system is susceptible to disasters. The degree of vulnerability is determined by a combination of several factors, including hazard awareness, the condition of human settlements and infrastructure, public policy and administration, and organised abilities in all fields of disaster management.

    Biomedical Model: The dominant Western model of health based on the scientific method and a positivist approach that asserts that the only viable knowledge is that which is gathered through scientific test methods and research. Involves a distinction between the body and the mind in dealing with issues of health.

    Biopsychosocial Model: The emerging view that health is a product of the biological, psychological and social aspects of the human being. A view that challenges the idea that health and illness are just products of biology.

    Complementary and Alternative Medicine Systems: All health care systems, and their theories and practices, other than the dominant paradigm of health care at the time. In the present context, in most countries, the term refers to all health care paradigms other than biomedicine.

    Empowerment: A process that increases the power available to the disadvantaged and provides them with the skills, knowledge and attitude to effectively make use of this power.

    Integrative Medicine: A model in which different healing modalities, including biomedicine, work in partnership towards optimising health outcomes. Focuses on all aspects of the person, including body, mind and spirit, and emphasises health rather than illness.

    References
    Australian Bureau of Statistics (ABS). 2008. National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Canberra, ACT: ABS.
    Commonwealth Department of Health and Aged Care Australian Institute of Health and Welfare. 1999. The National Health Priority Areas Report on Mental Health. Commonwealth of Australia, Canberra.
    Commonwealth of Australia. 2009. Fourth National Mental Health Plan-An Agenda for Collaborative Government Action in Mental Health 2009–2014. Canberra.
    Herman, J. L.2003. ‘The Mental Health of Crime Victims: Impact of Legal Intervention’, Journal of Traumatic Stress, 16 (2): 159–166. http://dx.doi.org/10.1023/A:1022847223135
    Jones, J.S.1981. ‘How Different Are Human Races?’, Nature, 293: 188–190. http://dx.doi.org/10.1038/293188a0
    Wilson, M.2010. Criminal Justice Social Work in the United States: Adapting to New Challenges. Washington, DC: NASW Centre for Workforce Studies.
    Web Resource

    Appendix 2: Reflective/Practice Questions

    The authors of the respective chapters have provided a number of practice/reflective questions. They are presented here according to the chapter numbers. You are invited to look at these questions and engage in critical reflections which will enhance your practice. Some of the questions are based on case studies and they are presented here as well. All other questions are related to the concepts and ideas expressed in the chapters.

    Introduction
    • What are the key concepts discussed in this chapter and how they could be applied in your practice setting?
    • Discuss the concept of mental health and mental illness in the light of the policy documents.
    • What is your understanding about mental health?
    • How would you compare the best practices within these case studies?
    • If social stigma is a major concern, what services would you recommend bringing together at the community level?
    • If this chapter has rendered a face to the statistics within the MHA 2011, research, for example, the differences in SAARC countries? Or the Continent of Africa or the Pacific rim?
    • What are some of the challenges for mental health care in India?
    • What are multifaceted interventions and how can that can be carried out?
    • Discuss the Institutionalised mechanisms for mental health care in India.
    • Discuss the issue of human rights of persons with mental illness. What are some of the roles of social workers in this context?
    • What is community mental health and what has been the latest development in the field?
    • What is the scenario of mental health in India?
    • How mental health is viewed by people of India?
    • What are the various developmental stages in the history of mental health in India?
    • What are the policies and programmes in mental health practice in India?
    • What are the issues and challenges in mental health practices in India?
    • Discuss the context of Mental Health Care system in the State.
    • Discuss the major challenges in the Mental Health Care practice in the State.
    • How do we integrate different systems for the better Mental Health Care in the State?
    • What is the relevance of collaborative efforts in enhancing the quality of mental health care?
    • What are the core values that underpin the recovery paradigm?
    • What social work knowledge and skills could be used in working with a consumer towards their recovery?
    • What new ways of working and thinking do you need to embrace?
    • What is your professional recovery plan?
    • What are the structural impediments faced by consumers in their recovery journeys?
    • How might social workers and consumers work towards a more just and inclusive society?
    • To start with, apply this question to yourself: How will your best friend discover that a miracle happened to you?

      The reason for adding such a reflective practice question is to test for yourself the power of this question and to feel the unfolding of a fascinating possibility.

    • We are hoping that this chapter spoke of various possibilities. Can you once again apply this question to self and describe in concrete terms what one thing you read was useful to you?
    • What will be different, even something small, which will change your way of taking history of your client?
    • How will that make a difference?
    • Are traditional assessment frameworks such as the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) deficient and misleading in categorising and describing the experiences of non-European people?
    • How do social workers provide culturally appropriate services?
    • How do social workers deal with the stigma attached to the diagnosis of mental illness?
    • What are some of the mental health issues relating to refugees in general?
    • How can positive psychology enhance the skills and knowledge of social workers when dealing with mental health issues?
    • What are the challenges faced by human service professionals in working with refugees?
    • How can information from this chapter be used in your professional practice?
    • What practice frameworks can be developed from this chapter?
    • Why would a social worker even want to assist and support mentally ill offenders?
    • What challenges would a social worker face when attempting to provide assistance and support to victims of crime?
    • How would you encourage social work students to become more involved in the provision of mental health services to prison inmates?
    • Why is it important to understand male coping in the context of what society expects of men?
    • What might be some negative consequences of not understanding male coping in its proper relation to male physiology?
    • For what reasons is it important to identify the effects of alcohol on a man's mental health, before commencing any therapy or intervention with him for a mental health problem or disorder?

    Please read the following case study and address the questions that follow.

    You are working as a counsellor in a women's health centre. Mrs X, a 58-year-old woman, comes to see you. She has been experiencing escalating levels of physical violence from her husband and she has presented to her GP several times with multiple injuries and once had to be attended at the hospital emergency department. She explains that her husband loves her deeply but is going through a hard time after being retrenched from work. He is drinking more frequently and the violence tends to occur after drinking. She informs you she has no friends or family. Her adult children have moved away and do not keep in touch. She is convinced that the alienation of her children and her husband's violent behaviour are both due to her inadequacies as a wife and mother. She feels that if she could communicate with her partner in a more open and frank manner, her problems would be resolved. Lately, she has been feeling ‘down’ and anxious, she cannot sleep and has frequent panic attacks.

    Reflective/Practice Questions
    • What are your reflections on the story of Mrs X from the case study above? What are the social and environmental considerations that you would put a gender lens to?
    • What gender analysis is needed to assess the mental distress symptoms?
    • How could feminist therapy be useful to working with Mrs X?
    • What are the implications of Mrs X for the work of your health centre?
    • How would you define a disaster as distinct from an emergency and what are the possible psycho-social ill-effects on individuals and communities?
    • What is the role of a mental health worker in enhancing psycho-social well-being of individuals and communities in the context of a disaster?
    • Describe the concept of vulnerability, the vulnerable groups in a disaster situation and indicate the interventions necessary to ensure their psycho-social well-being.

    Please read the following case study and address the questions that follow.

    N- is a 42-year-old woman who has been referred by her general practitioner to the mental health service that you work in as a social worker. She complains of severe headaches, pain in her joints, breathing difficulty and insomnia, all of which she has had for several years. N- is of refugee background and has been resettled in for the last three years. She originally lived in Burma (Myanmar) until her village was attacked by the military and her husband was killed in the fighting. She was forced to flee to a refugee camp in Thailand where she lived for four years before moving to her new home in the country that she lives in. She had lived through many traumatic events over a long period of time, but was not diagnosed with posttraumatic stress disorder during her settlement.

    N- has been to several general practitioners for her physical problems and has been treated for many of her issues independently of each other. As an example, when she complained of pain in her wrist, she was diagnosed with repetitive stress injury and went through surgery for the problem, despite the fact that she also had pain in her shoulders and in her knees. She has also been to a psychiatrist a few times and was put on medication which she did not take as she did not trust the psychiatrist. She was not comfortable talking to the psychiatrist as he had implied that her problems were ‘in her head’ while she felt that the problems were in her body. N- speaks longingly of the relief that she used to get from her pain when the children in the refugee camp used to walk on her back, a traditional practice among their community. Unfortunately, her own children are all grown up and, she feels, moving away from her because of the culture they are absorbing in the new country. She is unable to enter the workforce because of her ongoing health issues and she feels very lonely.

    Reflective/Practice Questions
    • What are your reflections on the story of N- presented in the case example, especially in the context of the biomedical model and the issues discussed in this chapter?
    • Can you identify any options other than medicine or talk therapy that could be of benefit to N- and can you identify them?
    • If so, how do you think they would work in collaboration with biomedicine in supporting health needs of N-? If not, how do you think the present system could be improved to support her health needs better?
    • Can you think of issues in terms of adopting an integrative medicine approach in your own practice, and what you could do about them?
    • In the context of the mental health system in your country, can you identify any elements of integrative medicine practice and discuss their effectiveness? If there are none, can you think of opportunities for constructive change?

    About the Editor and Contributors

    Editor

    Abraham P. Francis is a senior lecturer at the James Cook University in Australia with international exposure and extensive experience in community development and mental health. He taught social work at the Delhi University in India and also worked as a senior mental health social worker with the Country Health South Australia, before moving to Townsville to join the James Cook University. He held a stint in Queensland health as Assistant Director of Social work. Dr Francis is associated with many voluntary organisations, associations, professional bodies and developmental projects, both in Australia and India. Dr Francis has established international partnerships and research collaborations with universities and non-government organisations in Asia. He is the convener of the international consortium on strengths-based social work practice in mental health and has been the founding honorary director of the DePaul International Centre for Wellbeing, India. Dr Francis is passionate about working and researching in strengths-based practice in mental health. His other research interests are in the field of communities, criminal justice, international social work and gerontological social work. He can be contacted at abraham.francis@jcu.edu.au

    Contributors

    John Ashfield, PhD is the Director of Education and Clinical Practice, at the Australian Institute of Male Health and Studies, and an Adjunct Senior Lecturer at the University of South Australia. Widely recognised for his work and writing in the fields of mental health and male psychology, he is the author of six books, a number of scholarly articles, essays, and published health promotion resources. He was the founder and Director of the India Overseas Sharing Fund, a community development organisation working with the poor in Chennai and Pune in India. He has worked in private practice, government and public sector settings, in the health, welfare and community development fields. He was formerly a Principal Consultant (Mental Health) for the South Australian Health Department, and has developed a range of mental health programmes and initiatives that have been utilised at both state and national levels, and overseas. He has taught in postgraduate programmes (including social work) at several Australian universities, and was a pioneer of postgraduate education in psycho-oncology and palliative care. He also continues to work as a psychotherapist in private practice.

    Hurriyet Babacan is Professor of Social Work and Development at the University of New England, Australia. Earlier, she was Foundation Director of The Cairns Institute at the James Cook University, Townsville. She has had a distinguished career over the last 30 years in senior roles in higher education, public administration, and research and training. She has published widely in national and international publications on a range of issues including international development, public administration, cultural diversity, gender, health, and economic and community development. She has authored numerous books and articles, including two publications for the UNESCO. She has delivered keynote presentation at numerous national and international conferences and served on numerous ministerial and expert advisory committees. She has been a member of two working parties for the Council of Europe/OECD on measuring well-being and social progress. She has led numerous national and international leadership, research and development projects, particularly in the Asia-Pacific. She has been recognised for her work through a number of awards including the Bi-Centenary Medal awarded by the Prime Minister (2002) and the Multicultural Services Award by the Premier of Queensland. She was the Queensland State Finalist in the Telstra Business Women's Award in the Government and Public Service category in 2003.

    Robert Bland holds the Queensland Health Chair of Mental Health in the School of Social Work and Human Services, University of Queensland. He graduated with a BSW (Hons) from that university in 1971 and completed MSW in 1978 and PhD in 1987. He has worked as a mental health social worker for Queensland Health for many years, including positions in hospital and community settings. His research on the family experience of schizophrenia led to the establishment of a family intervention programme at the Princess Alexandra Hospital in Brisbane, and this programme has been adapted for use in mental health settings across Australia. He returned to the University of Queensland as a lecturer in Social Work in 1990. In 1998, he joined the University of Tasmania as Professor of Social Work and Head of School. He has been active in a number of national committees for the Australian Association of Social Workers, including the mental health committee and the practice standards committee, and the Mental Health Council of Australia. He has been President of the Australian Council of Heads of Schools of Social Work, and a member of national boards of NGOs, including Anglicare Tasmania, Aspire and NEAMI. He has published widely in the area of social work and mental health practice, and has been a keynote speaker at national and international conferences in mental health. His research interests include social work practice, practice standards, families and mental health, spirituality and mental health, and social inclusion.

    Mark David Chong is the Director of Research Education as well as Lecturer in Criminology and Criminal Justice Studies at the School of Arts and Social Sciences, James Cook University, Townsville (Queensland, Australia). He is also an external assessor (grant applications) for the Social Sciences and Humanities Research Council of Canada. He graduated with a PhD in Law from the University of Sydney, where he received his Law School's Longworth Scholarship (2003), the Cooke, Cooke, Coghlan, Godfrey and Littlejohn Scholarship (2004), and the Longworth Scholarship for Academic Merit (2006). His research interests include social problems, criminal justice social work, social control and law and order issues, policing, crime prevention and community safety, punishment and sentencing, municipal and international criminal law, juvenile justice, and psychology and crime.

    Jamie D. Fellows teaches Criminal Law in the School of Law at the James Cook University, Townsville (Queensland, Australia). He is engaged in a number of research projects that include aspects of criminal law sentencing and punishment, jurisprudence and the nature of criminal law, and the limits to state authority. He is working towards completing his PhD on certain aspects of international criminal law.

    Brian D. A. Fernandes, currently a senior HR and business consultant, advises small and medium businesses on HR, governance and CSR issues. An alumni of Roshni Nilaya's Post Graduate School of Social Work, Mangalore, India, he is a dynamic and skilled manager with 26 years of diversified local and international experience in leadership roles in the Human Resource function. He is also involved in training activities and has written and presented papers at several seminars.

    Narayan Gopalkrishnan is an internationally recognised academic with extensive experience in Australia, India and other countries, working in universities, NGOs and the private sector over the last 25 years. He lectures at the James Cook University in the Department of Social Work, especially in the areas of community work, working with diverse communities and mental health. He was the founding Director of the Centre for Multicultural and Community Development, an academic research centre of the University of the Sunshine Coast, Australia, which focused on research and development relating to multiculturalism and community development. His teaching and research interests relate to community development, community and ecological sustainability, cultural diversity and multiculturalism, mental health, social determinants of health and well-being, and integrated medicine and complementary therapies. He has published widely in these areas.

    Wendy Li is Lecturer in the Department of Psychology, James Cook University, Townsville (Queensland, Australia). As a China-born, China- and West-trained academic, she positions herself between the East and West, informing Western social sciences with Eastern knowledge and vice versa. She has extensive research experience in ageing and geriatric mental health, cultural diversity and discrimination, intergroup relations, migrant and refugee mental health, and problem gambling and addiction. She has managed and led projects in Australia, New Zealand and China relating to a range of social issues, including ageing, mental health, migration, refugee and education.

    R. Srinivasa Murthy was Professor of Psychiatry at the National Institute of Mental Health and Neurosciences (Bangalore, India) and the Head of the Department of Psychiatry (1988–1997). He has been one of the leaders in the development of community mental health programmes in the country. He was a member of the team that developed the Bellary District Mental Health Programme. He was officer-in-charge of the ICMR Advanced Centre for Research in Community Mental Health (1985–1990) and has greatly contributed to the implementation of the National Mental Health Programme in India. He has authored over 10 manuals of mental health care (for non-specialists) and co-edited many books on mental health in India. He has worked with the WHO extensively. He functioned as the Editor-in-Chief of the World Health Report 2001. Following retirement in 2004, he worked with the WHO at Cairo and Amman, and on assignments assisted South Sudan and Somalia to develop country mental health strategy. He now works in Bangalore with a voluntary agency—The Association for Mentally Challenged—to develop a community-based care programme. He is also the Scientific Consultant (Mental Health) to the National Institute of Research in Environmental Health (Bhopal, India). In 2012, he was awarded the Professor Jose Lopez Ibor Award at the World Congress of Psychiatry in Prague.

    Rajeev S. P. heads the Department of Social Work at the De Paul Institute of Science and Technology (Kerala, India) and teaches Social Work at the postgraduate level. His research interest areas include family and child welfare, human rights and mental health practices. He is a research scholar in family and child welfare, and a postgraduate in Social Work and Human Resource Management. He has edited and co-edited books, and has published a number of articles in different journals. He is also associated with the James Cook University, Australia and the De Paul University, Chicago, for collaborative academic practices and cross-cultural programmes in social work.

    Venkat Pulla, PhD, is a Tata Dorabji Merit scholar from the Tata Institute of Social Sciences, India. Formerly, he was the Foundation Head of the Department of Social Work, Northern Territory University, Darwin, Australia. Dr Venkat Pulla more recently taught social work at the Charles Sturt University and is currently a Senior Lecturer, University of the Sunshine Coast, Queensland, Australia. His research interests are in human coping and resilience, spirituality, green social work and strengths approach to social work. He has founded the Brisbane Institute of Strengths Based Practice. He has co-edited papers on Strengths Based Practice in 2012; Perspectives on Coping and Resilience in 2013 and Community Work: Theories, Experiences and Challenges in 2014, with Kalpana Goel and Abraham Francis.

    Lena Robinson is Professor of Social Work at CQ University, Australia. Previously, she was Professor of Social Work at the University of the West of Scotland (UK). She has published and researched widely in the fields of race, ethnicity, culture and social work practice. She was involved in the international comparative study of ethnocultural youth and has recently completed a joint comparative study of Muslim youth in the UK and New Zealand. She is now involved in an international study of mutual intercultural relations in plural societies.

    Kamlesh Kumar Sahu is Assistant Professor in Psychiatric Social Work at the Institute of Psychiatry (Kolkata, India) and a doctoral research scholar in the University of Calcutta. He was educated at the Ranchi University (BA Sociology, MA Sociology) and the Central Institute of Psychiatry, Ranchi (MPhil Psychiatric Social Work). He has more than seven years of experience in the mental health field. He has worked as programme co-ordinator in the NGO Paripurnata (Kolkata), a lecturer in the Richmond Fellowship Postgraduate College for Psychosocial Rehabilitation (Bangalore) and a project assistant in the Institute of Human Behaviour and Allied Sciences (Delhi). His experience includes teaching and supervision of postgraduate trainees, as well as planning, execution, evaluation and co-ordination of counselling/mental health/psychosocial rehabilitation services and research. He has 20 research papers to his credit, presented in international and national seminars and conferences, and published in international and national journals. He is a life member of the Indian Society of Professional Social Work, individual member of the National Network of Schools of Social Work in India and International Association of Schools of Social Work, member of the International Federation of Social Workers and various Web-based professional networks. He has also served as guest editor and reviewer of journals, and has conducted a number of workshops in various institutions across India.

    Beth Tinning is a lecturer in the Department of Social Work and Community Welfare at James Cook University, Townsville (Queensland, Australia). Prior to her employment at the university in 2007, she worked as a social worker in government and NGOs. Over the past 20 years she has been employed as a crisis worker, responding to issues of sexual assault, domestic violence and mental illness. She has also worked in HIV/AIDS programmes and outreach homelessness services.

    Ann Tullgren is a retired social work practitioner in Hobart (Tasmania, Australia) and Associate Lecturer with the University of Tasmania. She has worked in a range of health and welfare settings, most recently as a social worker for Centrelink. She has also taught at the University of Queensland. She has a long record of activism in mental health and has been able to use her lived experience as a mental health consumer to enrich her writing and teaching in social work practice in mental health. She is co-author of a social work text book, and contributor to local and national educational projects around mental health in the social work curricula in Australia.

    Sebastin K. V. is Associate Professor in Social Work at the School of Social Work, Roshni Nilaya, Mangalore (Karnataka, India). He has 13 years of experience in teaching postgraduate students of social work. He obtained PhD in Social Work from the University of Mysore. He has published several articles in national and international journals, and edited volumes and presented papers in various national and international forums.


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