Our opportunity to help shift the mental health care system

A recent report on CTV Atlantic, featuring grassroots organizer Laurel Walker, shares the story of a group pushing the health authority’s to revamp our province’s mental health care.  The report indicates that 42% of Nova Scotians have reported that they have dealt with a mental health issue in their lifetime. This is one the highest rates in Canada. 

Our current mental health care system has a worldview that is firmly embedded within the medical model. This has created a system in which you need to be sick enough to receive services. The medical model will diagnose and treat symptoms for those who are severely ill and focuses on institutionalized approaches to treatment that stacks resources into emergency rooms and hospitals instead of communities.

It seems clear that this approach is not in the best interest of the public. Early care has been demonstrated to lead to better outcomes. However, Nova Scotians are not getting the care they need before they are in crisis.

Our mental health care system is desperate need of a shift. As a profession, we can lead that shift.

Social workers have contributed significantly to our health and mental health care systems for over 100 years. In a 2001 study, Gail Auslander outlines the top 20 ways social work has contributed to health care. She identifies how the profession incorporated bio-psychosocial and other holistic approaches into of mainstream health care. Social workers have promoted the importance of emotional, social, family, economic and cultural influences on health. We have developed culturally safe practices to suit the needs and beliefs of clients who use the system. As a profession, we have used our social work values to advocate for patient rights and to positively influence healthcare institutions.

At the forefront of these contributions is our fundamental beliefs in human rights, equity, and social justice.  Our value-based critical thinking allows us to articulate and identify the detrimental impacts of the social determinants of health, the importance of trauma-informed care and moves us to advocate to strengthen universal health care across Canada.

Despite these achievements, there is a long-standing tension between social work and the medical model. This tension dates back as early as 1917 when Mary Richmond wrote her book “Social Diagnosis.” She noted that when other professions do not understand social work’s distinctive contributions they will try to fit social work into their own worldview and practices.

At the root of this is age-old tension lies the supposed dichotomy between feeling and thinking. This dichotomy has been packaged as emotion vs. rationality and is, of course, a highly racialized and gendered argument (ie. women feel, men think). Equity within the workplace is an issue that continues to impact how we build our systems. “Rational” physiological issues continue to dominate how we frame mental health care and approaches embedded in an “emotional, social, economic and cultural” analysis are often marginalized. Feminists have spent a long time trying to destabilize this false dichotomy between rational and emotional thought. They’ve argued that we can’t separate rationality from emotion nor emotion from rationality, they are not distinct or separate forces but integrated with one another. This false dichotomy needs to be challenged through an intersectional lens to build a mental health care system that meets the needs of Nova Scotians.

Our province’s health authorities have released their strategy to transform our mental health and addiction services. To create this strategy, they have analyzed the current service delivery issues, treatment approaches, and resources allocated. They have examined population data and the impacts of the social determinants of health and the need to address social inequities. The strategy highlights the need for trauma-informed practice, and cultural safety within services offered.

This creates an opportunity for social workers to lead the change in our mental health care system. There is an opportunity for us to clearly articulate that these areas are a distinct space where social work has operated for over a hundred years. We have an opportunity to align ourselves with feminist theory and dismantle the false dichotomy between rational and emotional thought and to articulate that an intersectional, inter-disciplinary and collaborative approach will result in far better outcomes for Nova Scotians.

To build our professional capital and to articulate our profession’s distinctive space within the mental health care system we’re inviting social workers and stakeholders to join us Saturday, April 14th as we identify the principles that will guide and support the College’s advocacy for a better mental health care system. A system that operates in the public’s interest.

There is little doubt that without a strong organized voice that challenges the dominant worldview that the health authorities will continue to prioritize a mental health care system that is framed through physiological issues, treatments and approaches rooted in the medical model. This is the model that the health authority administration is embedded in and most comfortable with.

This is an opportunity for the social work profession to lead the development of a mental health care system embedded in the principals of human rights, equity, and social justice.

We hope to see you there.

When: Saturday, April 14, 2018, from 10:00 AM to 3:30 PM

Register here

Alec Stratford
Registrar/Executive Director