Engaging with Transformative Paradigms in Mental Health

Abstract

When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.

“My Voice Was Discounted the Whole Way Through”: A Gendered Analysis of Women’s Experiences of Involuntary Mental Health Treatment

“…This study mirrors other research that has reported on the significant harms, disempowerment and deprivations experienced by survivors of involuntary treatment (Watson et al, 2014;Whitaker et al, 2021), however through the use of a gender lens, the heightened and specific harms experienced by women have been made visible. For example, participants described gendered impacts of medication, the disruption and undermining of women's roles and identities as mothers, the refusal to provide pregnancy and fertility information, the pathologisation of women's emotions and sexuality, and the use of diagnostic language to conceal the experiences and impacts of gendered violence.…”

“…The extant literature demonstrates the dominance of a medical-custodial approach within hospital settings, which frequently exacerbates rather than alleviates distress, for example, through the trauma and humiliation of having belongings confiscated and being strip-searched (Prytherch et al, 2021). Whitaker et al (2021) note that it is common for people with psychiatric diagnoses to be subjected to an ongoing cycle of involuntary admissions, which can be spirit-breaking. A recent report released by the World Health Organization (2021) cites similar concerns that people subjected to coercive practices “report feelings of dehumanization, disempowerment, being disrespected and disengaged from decisions on issues affecting them … leading people to avoid seeking care and support.” Ross (2018) questions the legal sanctioning of treatment without consent, given that people with psychiatric diagnoses are no more dangerous than the general population, and that interventions such as seclusion involve extreme deprivations of liberty that cause harm for the majority of people and lead to re-traumatisation for people who have previously experienced violence.…”

“…Concerningly, social work has largely demonstrated implicit support for involuntary treatment, by seeking to improve social work practice within involuntary settings rather than to outright challenge or contest it (Maylea, 2017). At the same time, a growing social work critique of biological and diagnostic understandings of mental distress, alongside social work scholarship demonstrating the incompatibility of involuntary treatment with recovery or mental wellbeing, means that social work is well-positioned to engage in more radical and robust critiques of involuntary treatment, as well as contributing to alternatives (Whitaker et al, 2021). Although involuntary treatment is often justified on the basis that the alternative would be to neglect people experiencing significant distress (Maylea, 2017), ceasing a reliance on force and coercion opens up an array of opportunities for providing support and new responses to distress that are focused upon social justice, agency, human rights, recovery and meaning-making, as a replacement for medicalised understandings of distress based on notions of individual pathology and narrow risk discourses (Watson et al, 2014).…”

“…The extant literature demonstrates the dominance of a medical-custodial approach within hospital settings, which frequently exacerbates rather than alleviates distress, for example, through the trauma and humiliation of having belongings confiscated and being strip-searched (Prytherch et al, 2021). Whitaker et al (2021) note that it is common for people with psychiatric diagnoses to be subjected to an ongoing cycle of involuntary admissions, which can be spiritbreaking. A recent report released by the World Health Organization (2021) cites similar concerns that people subjected to coercive practices "report feelings of dehumanization, disempowerment, being disrespected and disengaged from decisions on issues affecting them … leading people to avoid seeking care and support."…”

Positive Mental Health Literacy: A Concept Analysis

“…The PMeHL concept is considered a component of MHL, integrating positive mental health, which deserves attention throughout the lifespan in different contexts and intervention levels. Emphasis on person-centerd care calls for a transformation of the mental-ill health paradigm ( Whitaker et al, 2021 ). Thus, PMeHL can be operationalized in two ways: (a) as a resource or potential mediator between individual determinants and health(-related) outcomes and (b) as an outcome when attempting to decrease the impact of social/contextual inequalities on health(-related) outcomes.…”