Sunday, January 16, 2005

Another chapter summary from my social services text.

H. Wayne Johnson
Mental Health and Social Work
Chapter Nine
Verne R. Kelley

In Mental Health and Social Work, Verne R. Kelley gives a brief history of the treatment of mental disorders and current role of social health today. From the earliest of recorded history, through several major turning points in mental health treatment, he points out what worked and what didn't. Then he describes the challenges currently facing mental health social work today, as well as the trends in the field of mental health.

From the very start, Kelley tackles the very definitions of “mental disorder” (p. 157) and “mental health” (p. 158). He explains that because of the complexity of emotional disturbances, the term “mental disorder”is not defined. In fact, he notes that the DSM-IV says there is no definition that can adequately specify the boundaries of mental disorders (p. 157). Instead the DSM-IV deals with the classifications of disorders people can have. Rather than labeling a person a “schizophrenic”, it uses the more accurate term “person with Schizophrenia” (p. 171). For “mental health”, Kelley draws on Robert White's definition of an “organism's capacity to interact effectively with its environment“ and ”one's confidence of being able, when necessary, to have desired effects“ (p.158).

Summarizing the history of mental health, Kelley focuses on the ambivalence of Western society in its diametric approaches of compassion and intolerance (p. 159). The first hospital exclusively for the mentally ill was created in A.D. 490 (ibid.), based on the concept of compassion. It was not until the Middle Ages that mental illness was linked to witchcraft by two Dominican monks (ibid.). As mental health facilities where introduced in the New World, the concept of “moral treatment” was a strong one versus the old treatment of just locking these people away in places like “Bedam” in London and Bicôtre in Paris. With “moral treatment” recovery rates as high as 72 percent, it is no wonder it is still practiced today in concert with other treatments (ibid).

Yet, history has shown a cycle of humane versus inhuman treatments for the mentally ill. Some of that can be attributed to the success of the earlier hospitals, causing them to be over-utilized and leading to the “snake pit” conditions in the early twentieth century (p. 160 - 161). Funding, skilled staff and available facilities limit the amount of people that can be helped and in what capacity. Many institutions have found alternate ways over the years to overcome these obstacles (p. 162).

Other turning points in mental health history are the works of Sigmund Freud and the concept of community mental health care. Freud proved that there were systems and patterns to mental disorders and the National Mental Health Act of 1946 helped states to create a network of community services, as well as fund the research and education of mental health professionals (ibid). In addition to community mental health centers, this also led to the development and increase of: university training and research facilities; military social work; private practices; and alcoholism and drug abuse services (p. 164-165).

Somewhere along the line, the idea of preventing emotional disorders came into being. Prevention “assumes that the best way to ward off maladaptive problems is to equip people with the personal and environmental resources for successful coping“ (p. 166). An offshoot of this belief has lead to the development of many early childhood programs and is currently behind the idea of giving training and support to parents to be (p. 167). Still, some traumas cannot be foreseen. This fact has lead to the increase of emergency and short-term assistance programs like telephone and walk-in crisis centers (p. 167).

The roles of social work in mental health ranges from client advocacy between organizations and family to coordinating community services for the client. The demands of funding and need, as well as overseeing agencies and “care for profit” management present many challenges to today's clinical social worker and other mental health professionals and many are resorting to creative ways to meet these demands(p 173).

This insightful chapter gives a very good overview of successful mental health care. It is sad that many policymakers are unaware of the successful trends or choose to ignore them based on the mind set of intolerance towards those with these difficulties. Still, this challenges those working in this field to work harder to find better solutions.

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