Human rights must be part of everyday practice in mental health social work

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Social workers call on CORU to reinsert references to human rights into the Social Work Code of Professional Conduct and Ethics

Approximately 1 in 4 people will seek support for mental health issues at some stage in their lives (Golighthley and Goemans, 2020). Often this may involve accessing help and support from a social worker, usually as part of a multidisciplinary team, whose role is to help, support and empower mental health service users. The conventional assumption that mental health services are rationally delivered and benefit all citizens has however been challenged in recent decades. For example, criticisms have been made that decisions made by mental health professionals can lead to forms of iatrogenic harm such medication only regimes, and forms of compulsory treatment that neglect the rights of citizens. There are also concerns that mental health services create or reinforce systems of power and inequality which tend to disadvantage those who receive the services (Campbell, Brophy and Davidson, 2022). We argue below that it is important to reflect upon the interfaces between social work practice and issues of  mental health and human rights.

It has been argued that, at its core, social work should be committed to challenging inequality, promoting social justice and human rights (Ife, Soldatić and Briskman, 2022). These aspirations are underpinned by the Global Agenda for Social Work (IFSW, 2018) which emphasizes the importance of the profession in contributing to  policy development as a way of  promoting equality, providing advocacy, and upholding the human rights of mental health service users. This has led to shifts away from deficits to strengths-based perspectives when intervening in the lives of service users:

 ‘We have to break from the professional doctrine that ascribes virtually all of the problems which people experience to deficits in personality development and family relationships…It is an ideology that directs them to blame themselves for their travails rather than the economic and social institutions that produce many of them’ (Cloward and Fox Piven,1975 in Healy, 2000, p. 57). 

This implies that social workers should challenge unjust policies and practices, discrimination and institutional oppression as well as ensuring access to equitable distribution of resources and the upholding of human rights (IFSW, 2018).  In doing so, social workers should strive to act as ‘change agents’ for communities and society as well as individuals and families. It is argued that, when social work interventions are informed by a human rights approach, then professionals can be more prepared to question forms of research, policy and practice that potentially jeopardize empowerment, autonomy, and human rights of people accessing mental health services. 

Policy in practice in mental health social work

When adopting a human rights lens to social work practice, it is crucial to consider the complex relationships between the individual, society, and the state. Mental health social workers must find a way to respond appropriately and sensitively to those who use its services in relation to both social structures and individual needs. These intentions are often challenged by the sometimes contradictory judgements about the principles of citizenship when juxtapositioned alongside neoliberal and consumerist policies (Lymbery, 2014).

Other practice dilemmas occur when issues of capacity and incapacity occur in adult safeguarding contexts; recent Irish capacity legislation importantly expects professionals to assume that citizens have capacity to make decisions about their lives unless assessed otherwise. In such complicated circumstances, mental health social workers must balance a range of complex rights and responsibilities to ensure adults are able and empowered to protect themselves. In the absence of this, there is a risk that human rights will be breached. The implication is that in supporting citizens to retain capacity, the chance that the State will become involved in their lives is reduced. Mechanisms for protecting the rights of adults commonly include: independent oversight of decisions, access to independent advocacy and several principles to guide practitioner interventions. Crucially such interventions should be to the benefit of the service user by ensuring that wishes are taken into account and the least restrictive option to secure protection is used (MacIntyre and Stewart, 2018). 

For mental health social workers, a key challenge is that they are tasked with both caring for those with mental health problems but also acting as ‘agents of control’ when people become unwell and may require inpatient treatment or detention against their expressed will and preference. The recent ‘Emily’, ‘Brandon’ and ‘Aras Attracta’ scandals in Ireland have however highlighted the inadequacy of our existing legislative framework to ensure protection of those in inpatient or residential care and the critical juncture between safety, protection and human rights has been amplified.

It is not just in the areas of policy and practice that the profession needs to attend to principles of human rights. In the area of social work education, a focus on social policy can prepare future practitioners to understand the relationships between, for example,  anti-poverty and housing/homelessness policies and mental health problems such as anxiety and depression. Importantly the registration body, CORU, now expects educators to engage with service users in the design and delivery of the curriculum. This implies a close relationship between the academy and service users and their representative organizations. These create opportunities for the lived experience of mental health service users to be incorporated into social work education programmes.

Mental health social workers are required to consider all these factors to ensure the rights of people and communities they work with, are upheld. In addition, from its earliest inception, social work has explicitly stressed the importance of a politically engaged form of praxis. Of particular note is the understanding that:

  • The problems faced by service users and consequently social workers derive from the capitalist structure of society and the place of policy and welfare within it: effective practice must stem from an understanding of how our health and social care system has developed, the pressures to which it is subject and the impact on human rights.
  • The principle of universal entitlement to welfare services has been gradually eroded in the post-war period, and responsibility for responding to social problems has largely transferred from the state to families. 

(Adapted from Case Con Manifesto, 1975).

For these reasons it is vital for the profession to start from a position where the problems of society are regarded as the outcome of political and policy choices rather than a sense of inevitability (Lymbery, 2014). An immediate practical and pragmatic way to embed this in practice is for social workers (and allies) to call on CORU (the regulatory body for social work) to reinsert references to human rights into the CORU Social Work Code of Professional Conduct and Ethics. References to the core social work values of social justice and human rights were removed from our legally binding code of ethics and conduct in 2019, with no explanation from CORU. We believe that in its current form, the social work code of ethics runs contrary to public sector and human rights duties, required of all public actors by the European Convention on Human Rights, the Irish Constitution and S.42 of the Irish Human Rights and Equality Act 2014.

Mental health social work and human rights in action

It can often be the case that social workers do not explicitly articulate human rights perspectives in everyday practice. As a profession based on advocacy and rights, it can be surprising for some to know that social workers aren’t always the best self-advocates, in terms of explaining our role to others and being clear and confident in publicly articulating the core values of the activity of social work. This may be because it is often suggested by social workers themselves that, ‘it’s just what we do’, or ‘we don’t need to say we do human rights, we just do it’. This, it is argued, is often a missed opportunity to contextualise practice through more radical, critical lenses which challenge forms of discrimination and injustice. This positioning is essential given the human rights abuses that have emerged in Irish society (some examples include the Tuam babies, Mother and Baby Homes, ‘Emily’ case and the ‘Brandon’ case). Mental health social workers need to highlight their role in protecting citizens from human rights abuses. 

In discussing such roles it is possible to demonstrate ways in which human rights perspectives are crucial to social work interventions and ways in which these can be realised by building systems of solidarity and alliances with communities to deliver progressive social change.

Using McPherson and Abell (2020) framework for rights-based social work practice, some tangible examples of human rights in social work in Ireland are outlined below. 

  1. Participation: mental health social workers have developed community-led mental health projects with the Traveller community which recognise the right of diverse and marginalised groups in society, to have full and equitable access to mental health services. 
  2. Non-discrimination: mental health social workers advocate with and for parents using mental health services. This is underpinned by the principle that they should not be discriminated against in their capacity as parents by the courts and child protection agencies just because they experience mental health difficulties. Practitioners regularly support parents, in particular women and mothers experiencing mental health difficulties. A ‘Think Family’ approach can be used to find ways to support children and parents to remain together (as opposed to forced removal of children from parents due to parental mental illness) while balancing risk and rights in a reasonable and realistic way, is a humane (and human-rights focused) way to engage with parental mental illness. 
  3. Strengths perspectives: mental health social workers often engage in psychosocial assessments and co-developing goals and plans that are fully led by citizens (whether as a service user or supporter).
  4. Micro/macro integration: Mental health social workers regularly engage in partnerships with service users to enable access to appropriate housing. In doing so it is important to connect individual housing issues to the collective housing problems faced by many people and communities. This can take the form of facilitating people to meet others who also face housing difficulties which can assist with the development of peer support networks and direct action. It can also involve interventions that support groups of people with direct experience of housing difficulties to collectively advocate for themselves through formal complaints processes, lobbying of public representatives and to engage in their civil liberty to peaceful protest. 
  5. Capacity-building: social workers in mental health have co-developed and co-taught mental health programmes developed specifically by the Traveller community, for the Traveller community which aim to enhance self-advocacy, peer support and justice-focused approaches to mental health within and across the Traveller community in a culturally appropriate and diverse way. 
  6. Community and interdisciplinary collaboration: social workers in mental health have led in the development of interdisciplinary approaches to ensuring the meaningful implementation of the newly enacted assisted decision-making legislation within the organisations and services they work in. This includes, but is not limited to, ensuring human-rights training is available to staff and supporting staff do this training; developing service-wide policies, procedures and concrete actions for services and staff to ensure consent, will and preference and right-based health; and that social care decision-making are core to the ethos of mental health service provision. 
  7. Activism: social workers collectively organised to develop grassroots groups during the Marriage referendum and 8th amendment referendum. This involved the use of expertise in non-discrimination and the social determinants of (mental) health, to campaign for constitutional change that recognised same-sex marriage and constitutional change that recognises reproductive justice in Ireland. 
  8. Accountability: When meeting people on an individual or group basis, social workers in mental health make sure to explain options, services, costs (if any) and possible outcomes of proposed choices. Clear explanations for how consent can be provided and withdrawn at any time are given. Mental health social workers clearly inform service users about complaints processes (including how to complain about experiences of social work interventions) and how to go about these if necessary. Very often, social workers in mental health will support people to make complaints and to navigate the complaints process. 

Conclusions and recommendations

Advocating and upholding human rights and social justice are core to the practice of mental health social work. It has been argued that failure to engage at a policy level has resulted in the profession (unconsciously or consciously) aiding neoliberal policy reform (Lorenz, 2005).  A radical analysis of social problems is necessary if service users, as people and citizens, are to make the best of their lives and opportunities, mental health and well-being. We argue that while the social work profession identified this mandate, these efforts could be further progressed and strengthened through collective advocacy in partnership with the mental health services users, the communities we work with, and the organisations that represent their interests, to demand meaningful policy and legislative reform and upholding of human rights for all.

You can sign an open letter to CORU here, you can sign the open petition here and you can follow the campaign on Twitter and Instagram (@SWs4Change) and by emailing us on SWs4Change@gmail.com.

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Kerry Cuskelly is a mental health social worker and Dr. Sarah Donnelly is an Assistant Professor of Social Work at the School of Social Policy, Social Work and Social Justice University College Dublin.

Kerry and Sarah would like to thank Prof. Jim Campbell, Emeritus Full Professor (RTA), School of Social Policy, Social Work and Social Justice for editing a final version of this article. 

References

Campbell J, Brophy L, Davidson G. (2022). Editorial: International Perspectives on Mental Health and Mental Health Social Work. International Journal of Environmental Research and Public Health. 19(12):7387. https://doi.org/10.3390/ijerph19127387

Golighthley, M. and Goemans, R. (2020). Social Work and Mental Health’,7ed, London: Sage.

Healy, K. (2000). Social Work Practices: Contemporary Perspectives on Change, London: Sage.

Ife, J., Soldatić, K., & Briskman, L. (2022). Human rights and social work. Cambridge: Cambridge University Press.

International Federation of Social Workers. (2018). Global Definition of Social Work, [online], Available from: www.ifsw.org/what-is-social-work/globaldefinition-of-social-work/  [Accessed 11 June 2023].

Lorenz, W. (2005). ‘Social work and a new social order: challenging new liberalism’s erosion of solidarity’, Social Work and Society, 3(1): 93–101. 

Lymbery, M. (2014). ‘Austerity, personalisation and older people: the prospects for creative social work practice in England’, European Journal of Social Work, 17(3): 367–382

McPherson J., Abell N. (2020). ‘Measuring rights-based practice: Introducing the human rights methods in social work scales’, The British Journal of Social Work, 50(1), pp. 222–42.

MacIntyre, G. and Stewart, A. (2018). ‘Safeguarding Adults With and Without Mental Capacity’ in MacIntyre, G., Stewart, A and McCusker, P. (eds) Safeguarding Adults: Key Themes And Issues, pp 53-70, Palgrave, London.

 

 

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