REPOSITIONING SOCIAL WORK

An essential paradigm shift in mental health

Sharing our sense of urgency for structural change

BY DR. WANDA THOMAS BERNARD, RSW

This article was originally published as a foreword in Repositioning Social Work Practice in Mental Health in Nova Scotia, which can be downloaded online at nscsw.org/reposition.

There is a growing body of research in Nova Scotia which recognizes the profound and harmful effects of racism on the health and well-being of individuals and communities, with calls to address disparities and inequities in health care, including the provision of mental health services (Beagan et al. 2012; Bernard et al. 2014; Etowa et al. 2017; James et al. 2010). In one research study, participants called for major systemic changes necessary for effective intervention and treatment to reduce the harms of mental health and addictions issues in the African Nova Scotian community (Willis, Berry & Bernard forthcoming). Many of the suggested changes focus on breaking the silence about these topics and reducing stigma. Furthermore, research findings have highlighted the need for more community-based supports and services to provide outreach, intervention and treatment for African Nova Scotians throughout the province. The Association of Black Social Workers (ABSW) has been attempting to fill the gaps in service provision for over forty years, yet the stigma prevails and efforts to ensure more culturally relevant mental services have not been realized.

As I read this research report, I became excited about the potential for systemic changes in mental health and addictions services at this time in our collective history.

I was especially drawn to the principles that have been identified for guiding mental health policy and approaches to clinical services. On their own, these principles could lead to a transformation of mental health and addictions services. The outcomes of the study Repositioning Social Work Practice in Mental Health in Nova Scotia clearly highlight the sense of urgency for structural change that my colleagues and I have been advocating for over many years. The study is comprehensive, inclusive and multifaceted, with multiple sources of data collection and analysis. The review of the literature is extensive and provides a rich context for the current study.

In Repositioning Social Work Practice in Mental Health in Nova Scotia, Drs. Catrina Brown, Marjorie Johnstone and Nancy Ross bring to light many of the problems with mental health and addiction services in Nova Scotia. It aptly points out ways in which the neoliberal government agenda has failed to adequately fund services that address some of the root causes of mental health issues as identified in the social determinants of health that are essential to health and well-being. In addition, the push towards victim blaming, pathologizing and individual responsibility, with little to no emphasis on culturally and socially specific services is very problematic. Critiques of the ‘bio-medical model’ and the adoption of managerial practices that promote efficiency, but are not trauma-informed, are clearly articulated through the voices of social workers, service users and supervisors who contributed to the research. The data analysis reveals the hard truth that social workers are undervalued and disempowered in mental health and addiction services. Furthermore, it is noted that social workers lack a strong voice to address the shortcomings that they are left to address in their work when caught at the intersection of the ‘dissonance between the dominant bio-medical and DSM-based model and the biopsycho-social social justice-based social work approach.’

Repositioning Social Work Practice in Mental Health in Nova Scotia concludes with a strong set of recommendations that are intended to transform the provision of mental health and addictions services in Nova Scotia. The recommendations cover a range of themes, including the need to reposition social work, to provide a guaranteed livable income and to integrate a more social justice-oriented approach in mental health and addictions practices. It is anticipated that the study’s findings will influence policy, practice and education in Nova Scotia which, if implemented, will certainly transform mental health and addiction services. There is significant emphasis on the need for a paradigm shift away from a biomedical model towards a ‘bio-psycho-social model’, that is rooted in social justice and the social determinants of health, for both prevention and service delivery.

In essence, this study can serve as a guidebook for actions that will improve conditions that will help to address some of the root causes of mental health and addictions issues. However, it can also be considered a blueprint for changes in policy and practices that reposition social workers in the service delivery models in Nova Scotia. Most importantly, it will provide clear direction to the Nova Scotia College of Social Workers’ Social Justice Committee to develop strategic priorities and directions to advocate for the desired outcomes.

As you read Repositioning Social Work Practice in Mental Health in Nova Scotia, consider actions that you can take, based on the position you hold. What will you do to help the Nova Scotia College of Social Workers move this work from research to action for change? As a social worker, and a founding member of ABSW, who happens to be moonlighting as a Senator, I look forward to continuing the essential dialogue needed to help shift the paradigm. I am deeply committed to help lead policy changes in mental health and addictions to more bio-psycho-social social justice-based social work practices.

REFERENCES:

Beagan, B.L., Etowa, J., & Bernard, W.T. (2012). ‘With God in our lives he gives us the strength to carry on’: African Nova Scotian women, spirituality and racism–related stress. Mental Health, Religion & Culture, 15(2), 103–120. 10.1080/13674676.2011.560145.

Bernard, W.T., Maddalena, V., Smith, D., & Njiwaji, M. (2014). The role of spirituality at end of life in Nova Scotia’s Black community. Journal of Religion & Spirituality in Social Work: Social Thought, 33(3-4), 353-376. doi: 10,1080/15426432.2014.930622

Etowa, J., Beagan, B., Bernard, W. & Eghan, F. (2017) “You Feel You Have to be Made of Steel”: The Strong Black Woman, Health and Wellbeing in Nova Scotia. Health Care for Women International. doi/ 10.1080/07399332.2017.1290099

James, C., Este, D. & Thomas Bernard, W. (2010). Race & wellbeing: The lives, hopes, and activism of African Canadians. Black Point, N.S.: Fernwood Pub

Willis, R., Berry, K. and Bernard, WT (forthcoming 2021). Out of the Shadows: Race and (dis)Ability among Black African Nova Scotians., in Africentric Social Work, Editors

DR. WANDA THOMAS BERNARD, RSW, is a highly regarded social worker, educator, researcher, community activist and advocate of social change. Dr. Thomas Bernard is an independent senator for Nova Scotia (East Preston), and a founding member of the Association of Black Social Workers.

What We Heard

Selected highlights from Repositioning Social Work Practice in Mental Health in Nova Scotia

The NSCSW is grateful beyond words for the moral courage of the social workers who participated in the survey and focus groups for this mental health research paper. We hope you see your voices and experiences reflected in its pages.

Read the full report, and the researchers' 29 recommendations for change, at nscsw.org/reposition.

Survey results

In our survey of social workers working in Nova Scotia's mental health system:

• 98% believed that there need to be changes made to the current provision of mental health services.

• 97% indicated that they did not believe there were adequate resources in the community to support the well-being of their clients (i.e. affordable daycare, affordable leisure, affordable housing).

• 85% believed there are not sufficient day programs or services available within the community for their clients such as drop-in programs, faith-based group activities, or volunteer work support.

• 96% responded that they experienced barriers to providing services which include a lack of resources, lack of control and lack of opportunity to implement change.

• 82% reported that their training and perspectives do not have enough recognition in the current service delivery system.

• Only 35% of social workers indicated they were satisfied with their current role.

Summary of recommendations from survey participants

1. Value social work professionals

2. Promote and strengthen social work professional identity and collective voice

3. Address institutional influences on social work practice (Dalhousie School of Social Work, NSHA, IWK, NSCSW, CASWE)

• Nova Scotia College of Social Workers should increase advocacy for social work profession.

4. Social workers need to have a specific Nova Scotia social work union

5. Restructure model of care: Reimagining the choice and partnership approach (CAPA) model

• Move away from efficiency and fiscally constrained services to client-centred service that is multidimensional rather than a one size fits all medical model.

• Incorporate bio-psycho-social collaborative and relational models for social workers that do not individualize, decontextualize and medicalize peoples struggles.

• Recognize the continuum of mental health distress that needs support, rather than focusing on the most extreme.

• Social work needs to work within the system to be the voice of social justice.

• Services need to be more varied in terms of choices, models of delivery, and number of sessions clients can be seen.

• Government needs to invest in basic needs. Increase client mental health service accessibility; address barriers.

• Client resources need to be increased.

• Community options need to be increased.

• Diversity and mental health inequity needs to be addressed in a culturally responsive way.

6. Co-occurring issues of mental health, substance use and trauma need more services

• Specific training related to working with the effects of trauma is needed.

• Specific training related to addiction and substance use is needed, including harm reduction and gender-specific and culturally appropriate approaches.

• An increased range of services specific to addiction services should include increases in non-profit community based programming and harm-reduction treatment programs. The programming needs to address the common co-occurrence of mental health issues and trauma.

Source: Brown,C., Johnstone, M., & Ross, N. (2021) Repositioning Social Work Practice in Mental Health in Nova Scotia. Available online: nscsw.org/reposition