Research to inform mental health practice: Social work's contributions

Although recovery from mental illness is now a real possibility, many Americans suffer its associated disabilities because of a fragmented, disconnected, and often-inadequate system of mental health care (President's New Freedom Commission on Mental Health, 2003). In fact, most people needing them do not have access to specialty mental health services. Older adults, children and adolsecents, individuals from ethnic minority groups, and low-income clients in public sectors are particularly plagued by difficulty in gaining access to quality care for mental disorders. Although these groups often do not reach specialty mental health care and many lack regular contact with a primary medical care provider, they are heavy consumers of social work services. As a way to help ensure access and earlier treatment to people with undetected mental disorder, the President's New Freedom Commission Report on Mental Health has targeted improving mental health care in readily accessible and low-stigma settings where a high level of risk for mental health problems exists, especially all federally funded adult and child health and human services (President's New Freedom Commission on Mental Health). Social work has a key role to play in improving the accessibility and quality of mental health care. Social work was designated as one of the four core mental health professions in the federal legislation establishing the National Institute for Mental Health (NIMH), and social workers are the largest group of mental health providers in the United States (SAMHSA, 1998). Social workers make up about 60% to 70% of the mental health work force and provide more mental health services in the community than any other profession (Ginsberg, 1995; Ivey Scheffler, & Zazzali, 1998; Lin, 1995; Redick, Witkin, Atay & Manderscheid, 1992). Mental health is the largest field of practice (Gibelman & Schervish, 1995) and the largest concentration for study among MSW students (Lennon, 1993). Howard and colleagues (1996) estimated that social workers spend more than half of their professional efforts providing mental health services. Mental health is a growth area in social work: NASW recently established a mental health section for members, and social work has more candidates in training than any other mental health profession (O'Neill, 2002; SAMHSA, 1998). Articles in this issue reflect social work's historic concern with people suffering from severe and persistent mental illness. Although the cost of mental illness is often quantified in terms of dollars spent on treatment or earnings lost because of illness, Hollingsworth highlights another important aspect of the high cost of mental disorder: the burden to family care across generations. She used quantitative data from an NIMH-funded longitudinal study of 322 women with persistent severe mental illness and qualitative data from semistructured interviews with 82 of the women to examine the contribution of mental illness to child custody loss. Her findings reveal that child custody loss is among the consequences of psychiatric hospitalizations. Findings also highlight economic, parenting, and social support correlates of custody loss, and underscore the importance of providing adequate support and resources for mothers suffering from mental illness. The generational impact of mental disorder was also the focus of study by Sales, Greeno, Shear, and Anderson, who examined whether maternal caregiving strain mediates between child and mother mental health problems. Their findings suggest that caregiving strain may be a pathway between a child's emotional problems and those of the mother and that a mother may have better mental health if she experiences less caregiving strain. These findings suggest the importance--for both the mother's and child's sake--of interventions to address caregiving strain in families of children with a mental disorder. Helping people with serious mental illness achieve their maximum functional capacity has long been a focus of social work practice. …