Beyond Balancing Competing Needs: Embedding Involuntary Treatment Within a Recovery Approach to Mental Health Social Work

Abstract

The recovery model of mental illness has become increasingly influential over the past two decades and while the synergies with social work are strong, there has been no examination of how social workers manage working within a recovery framework with involuntary clients in risk management-oriented settings. In this paper we report on a qualitative study with 10 mental health social workers exploring how such tensions are managed in everyday practice. While the social workers identified numerous dilemmas, they drew on a combination of recovery principles and social work values and practice approaches in an effort to move client agency closer to the centre of multidisciplinary interventions. We conclude that while the implementation of a recovery approach in the Australian mental health system has been at best uneven, its official embrace lends social workers a sense of legitimacy in advocating for client rights in the complicating context of involuntary community treatment.

Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis

“…Thus, Paul attributed successful recovery to a worker’s ability to apply equal value to both dimensions of practice by balancing these competing needs against each other [21]. …”

Therapeutic relationships and involuntary treatment orders: Service users' interactions with health‐care professionals on the ward

“…Others strongly resisted treatment and experienced their care as coercive and oppressive. This means that the provision of information about the ward rules, their treatment, and their ITO conditions, and encouraging patients to seek independent advocacy can be an important strategy (Bland et al 2009;Courtney & Moulding, 2014;Shepherd et al 2009). However, regardless of how participants experienced their involuntary hospital admission, they all spoke about how staff attitudes and behaviours had the potential to make difference to their experiences of the ITO and being admitted to hospital.…”

“…Some argue that risk aversion and involuntary treatment are inherently in opposition with recovery approaches, as involuntary care impacts on the ability to establish relationships, and has a potential negative impact on a person's long-term recovery (O'Hagan 2012). However, others argue that keeping a focus on recovery principles, such as valuing the lived experience and the healing potential of relationships, can offer a platform to resolve some of these tensions (Bland et al 2009;Courtney & Moulding 2014;Deakin Human Services 1999;Trotter 2006).…”

Risk, Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

“…It is accepted that this refocusing of mental health social work will not lead to the end of the need for restrictions and deprivations of liberty but, it is argued, it will affect the process, impact, frequency and duration of these types of intervention. It is encouraging that, as Courtney and Moulding (2014) found, individual social workers can manage to retain a recovery focus even in the context of risk and involuntary intervention. For this to become the general approach of mental health services it will be necessary but not sufficient for this to be reflected in education, training and supervision within services.…”

“…Courtney and Moulding (2014) in their qualitative study of social workers reported that practitioners do find ways of managing the "seemingly antithetical orientations" (p. 215) of involuntary intervention and recovery but that further education and training was needed on these complexities. Recent initiatives in Australia offer the type of structured guidelines that can effect purposeful changes to practice.…”