Social work practice in community mental health

Reprinted from SOCIAL WORK, Vol. 26, No. 1, January 1981 ocial work practice in community mental health Steven P. Segal and Jim Baumohl The authors analyze social work&#39;s role in community mental health and describe practice models that enable practitioners to contribute to the improvement of an individ- ual’s mental status while main- taining a view of the person in the environment and a commitment to the improvement of social life. Steven P. Sega], Ph.D., is Associate Professor and Director, and Jim Baumohl, MSW, is Field Research Specialist, Mental Health and Social &#39; Welfare Research Group, School of Social Welfare, University of Califor- nia, Berkeley. DURING the past twenty years, the mental health ﬁeld has become in- creasingly cognizant of the interaction between social life and mental status —a relationship that is the basis of traditional social work practice. So- cial work is committed to improving the interaction among individuals, among institutions, and between people and institutions to enhance the general quality of life. However, in mental health, the major concern (the “depen- dent variable” in research jargon) is mental status. This article is concerned with social work’s role in community A mental health: the activities that enable the social worker to contribute to the improvement of an individual’s mental status while maintaining a commitment to viewing the person in the environ- ment and to improving the overall quality of social life. ‘ BOUNDARIES As a profession, social work is con- cerned with all spheres of interaction between people and their envi- ronments. Social workers practice in the realm of formal organizations of care and control; are concerned with the social, psychological, and jural di- mensions of the family; and have be- come increasingly interested in the everyday support systems that function among friends and acquaintances. All these concerns have been identiﬁed, in one way or another, with the treatment of mental disorders or the promotion of mental health. To the consternation of many traditional mental health professionals, the field of community mental health has become so elastic that it now in- cludes almost all kinds of ameliorative activity. This expanded purview de- rives from the association of a myriad of social factors with the development of mental disorders and from the con- comitant tendency to equate social well-being with mental well-being. For instance, the relationship between so- cial class and mental illness and the relationship between social stress and mental illness clearly indicate that poor people are at the greatest risk of devel- oping mental disorders. Because of these relationships, it is tempting to conclude that full employ- ment, better housing for the poor, na- tional health insurance, and an array of poverty programs might be the best means to reduce mental disorders in a society. Unfortunately, there is little evidence to support this conclusion. Such policies and programs are laud- able in their own right, but their impact on the mental status of the individual is subject to question.‘ The equation of social well-being and mental well-being is like the Calvinist equation of wealth . with salvation: both are nice, but not necessarily related. I What does it mean, then, to “con- tribute to the improvement of individ- ual mental status” while “maintaining a commitment to improving the overall quality of social lifeq? The answer de- pends largely on how a mental health “problem” and a mental health “ser- vice” are construed. INAPPROPRIATE LABELS As one moves farther from the traditional concerns of mental health (with psychoses, for example), the re- liability of the assessment of mental status becomes poorer and the risk of &#39; inappropriately labeling “problems of livingq as “mental disordersq becomes greater. Similarly, when one ap- proaches human problems whose re- lationship to discernible mental dis- orders is ambiguous or distant, the definition of a “mental health service” becomes problematic. Current empirical understanding does not permit a more elegant solution in either case. Mental disorders are variously defined and diagnosed either in narrow or broad terms. And a mental health service is often what Congress, &#39; the National Institute of Mental Health, state legislatures, or local citizens’ ad- visory boards are willing to pay for. The clinical risks associated with in- appropriate labels make it incumbent on mental health practitioners to be speciﬁc and judicious in the use of labels. Further, the treatment of indi- viduals in mental health settings, as op- posed to social service or “genen&#39;cq settings, may discourage potential clients who “know” that only “crazy peopleq (or members of any devalued 16 0037-8046/81/2601/0016 $0.50 © I981, National Association of Social Workers, Inc.