The role of social workers in mental health care: A study of primary care centers in Mexico

Abstract

In Mexico, people with limited resources who seek specialized attention in mental health generally go to primary health care, where their first contact is with social workers. There is little information about the activities of social workers in the field of mental health, and little recognition of their role. The aim of this study is to characterize the role of the social workers in health centers in Mexico City. We used an exploratory sequential mixed methods design (QUAL → quan) in two phases. The first phase consisted of interviews with 15 social workers, and the second a survey of 92. The qualitative information was analyzed through the establishment of categories and subcategories, and the quantitative data using descriptive statistics. The results of the two phases were then triangulated. The majority of the social workers had specialized diplomas from technical high schools, with little training in mental health. They identified two types of patients, those with mental illness and those with emotional problems; the latter were the most common patients in the health centers. Patients with mental illness were given information and referred to specialists; those with emotional problems were given orientation, counseling, and referrals, and above all, they were listened to. We believe that these activities are important: given the shortage of specialists, they offer patients a space for catharsis, for venting their emotions. Social workers receive little recognition for this labor, a fact related to an institutional reproduction of medical authority that does not take into account the social view of illness.

The DNA of Social Work as a Partner in Primary Health Care

“…Proximity includes the importance of building close relationships with patients (Abendstern et al, 2014;Döbl, Huggard, & Beddoe, 2015;Saavedra, Berenzon, & Galván, 2019) or enhancing therapeutic alliances with them (Firth, Dyer, Marsden, Savage, & Mohamad, 2004). To enhance these connections and establish trust in the relationship, social workers aim to create a safe environment where patients can talk freely about sensitive issues regarding their health status (Rose, Hatzenbuehler, Gilbert, Bouchard, & McGill, 2016).…”

“…Regarding to Nicholas et al (2019), relational skills of social workers are therefore seen as essential in these settings. Further, proximity expresses itself in being present in the living environment of people, which can be reflected in home visits, dealing with psychosocial issues and social support in daily activities (Mizrahi & Rizzo, 2008;Reckrey et al, 2014;Saavedra et al, 2019). In this respect, a warm listening attitude is important.…”

“…In this respect, a warm listening attitude is important. However, Saavedra et al (2019)highlights the difficulty that activities as listening and giving support is not seen as important by the authorities because there is no place on a format to record it. In addition, several articles do not mention any specific ways of proximity (Towns & Schwartz, 2012), or only mention tasks where there is contact between the patient and social worker.…”

“…However, only a few studies (n = 4) clearly illustrate the process logic of social work in primary health care settings. In these studies, constant development, flexibility, complexity (Ní Raghallaigh et al, 2013) and giving a variety of answers on topics as mental health or financial issues (Saavedra et al, 2019) are seen as part of social work. As Nicholas et al (2019) summarizes: "it is thus important for social workers to be able to live in relative uncertainty -to 'live in the grey" (Nicholas et al, 2019, p. 9).…”

“…In this manner, Keefe, Geron, and Enguidanos (2009) stress the need for the social work role to be clearly articulated in order to collaborate effectively with other team members in primary health care. In addition, some authors point out that with certain patient populations, more specific knowledge about a sector or problem is required in the communication with patients and other professionals (Firth et al, 2004;Saavedra et al, 2019). For example, social workers are often concerned with substance use, suicidal ideation or specific problems on patients' mental health, like depression or anxiety (Ashcroft et al, 2019).…”