Tag: health

Ageism and Attitudes Towards Older People in Social Work: A Systematic Review of Operational Definitions

The issue of ageism remains a critical concern in social work, as this profession is deeply rooted in principles of social justice and advocacy for vulnerable populations. Given the increasing aging population worldwide, understanding ageism within social work practice is essential to ensuring the fair and respectful treatment of older adults. Despite its significance, defining and measuring ageism has been a complex challenge, as various conceptual and operational definitions exist in the literature. This study systematically reviews the operational definitions of ageism used in empirical research within the field of social work, shedding light on the prevalent measurement frameworks, existing gaps, and implications for future research and practice.

Introduction

Ageism, first coined by Robert Butler in 1969, refers to prejudice, stereotyping, and discrimination based on age. It is often considered the third major form of discrimination, following racism and sexism. While ageism affects all age groups, older adults are particularly vulnerable to its negative consequences. These include social exclusion, reduced healthcare quality, and limited opportunities for employment or meaningful participation in society.

In social work, ageism is particularly relevant, as professionals in this field are responsible for advocating for older adults and ensuring their access to adequate care and services. However, research indicates that ageist attitudes persist among social workers, often due to societal stereotypes, limited exposure to older adults, or misconceptions about aging. This study examines how ageism has been operationalized in quantitative studies within social work to understand how it is measured and conceptualized.

Conceptual Framework

A clear definition of ageism is crucial for developing interventions to combat it. This study utilizes the framework of São José and Amado (2017), which builds upon Iversen et al. (2009) and defines ageism as negative or positive stereotypes, prejudices, or discrimination based on chronological age or perceptions of aging. Ageism can manifest in various forms:

  • Cognitive (stereotypes): Beliefs about aging, such as associating older adults with frailty or cognitive decline.
  • Affective (prejudice): Emotional responses to older individuals, such as fear, discomfort, or admiration.
  • Behavioral (discrimination): Actions influenced by age-based bias, including exclusion, neglect, or preferential treatment.

Additionally, ageism can be:

  • Explicit or implicit: Conscious vs. unconscious biases.
  • Self-directed or other-directed: Internalized by the individual or imposed by others.
  • Positive or negative: Favoring older adults or discriminating against them.

Understanding these dimensions is essential to effectively measuring and addressing ageism in social work practice.

Methods

A systematic literature review was conducted using the PRISMA guidelines. The search focused on four academic databases (Scopus, PubMed, Taylor & Francis, and Springer) covering the period from 2000 to 2020. Keywords included “ageism” and “social work.” Inclusion criteria required that studies be empirical, quantitative, peer-reviewed, and focused on ageism among social work students or practitioners in Western countries. Qualitative studies, policy papers, and literature reviews were excluded.

Results

Study Characteristics

A total of 414 studies were initially identified, with 12 meeting the inclusion criteria. Most studies were conducted in the United States, while others took place in Greece, Spain, and England. Participants included social work students, practitioners, and faculty members.

Various validated scales were used to measure ageism, including the Attitudes Towards Older People Scale (Kogan, 1961), the Relating to Old People Evaluation (Cherry & Palmore, 2008), and the Facts on Aging Quiz (Harris et al., 1996). These scales primarily measured explicit, other-directed ageism.

Components of Ageism in Social Work

Findings indicate that ageism in social work is predominantly measured through cognitive and behavioral components, with limited attention to affective elements. The most frequently identified forms of ageism were:

  • Cognitive – Other-directed – Explicit – Negative: The most common form, involving negative stereotypes about older adults.
  • Cognitive – Other-directed – Explicit – Positive: Reflecting benevolent but potentially paternalistic views of older people.
  • Behavioral – Other-directed – Explicit – Negative: Observable discriminatory behaviors towards older individuals.

Notably, implicit and self-directed ageism were absent from the reviewed studies, indicating a gap in the literature and a need for broader measurement approaches.

Discussion

This systematic review highlights several key findings. First, the studies primarily focus on explicit, other-directed ageism, neglecting self-directed and implicit biases. This omission is critical, as implicit biases influence behavior in subtle ways that are difficult to detect yet have significant impacts on older individuals. Self-directed ageism, where older adults internalize negative stereotypes, is also underexplored despite its known psychological and physical health consequences.

Additionally, while most research examines negative ageism, the phenomenon of positive ageism—where older adults are stereotyped as wise, kind, or in need of special care—is also relevant. While seemingly benevolent, positive ageism can contribute to infantilization and disempowerment.

Strengths and Limitations

This review systematically examined empirical studies on ageism in social work, providing a comprehensive overview of how the phenomenon is operationalized. However, several limitations exist. The exclusion of qualitative studies means that nuanced insights into social workers’ attitudes and experiences may be missing. Additionally, most studies were conducted in Western countries, limiting the generalizability of findings to non-Western contexts. Finally, the absence of studies on implicit ageism suggests a need for further research using alternative methodologies, such as implicit association tests or observational studies.

Recommendations for Future Research and Social Work Education

To improve understanding and mitigation of ageism in social work, future research should:

  1. Expand measurement approaches: Develop scales that capture implicit and self-directed ageism to provide a more complete picture of how ageism manifests.
  2. Diversify study populations: Conduct research in non-Western settings to explore cultural variations in ageist attitudes.
  3. Investigate positive ageism: Examine how seemingly favorable stereotypes about aging influence social work practice and policy.
  4. Utilize mixed methods: Combine quantitative and qualitative research to gain deeper insights into the lived experiences of older adults and social workers.

In social work education, programs should:

  1. Integrate gerontological training: Ensure that all social work students receive education on aging issues to counteract stereotypes.
  2. Foster intergenerational interactions: Provide students with opportunities to engage with older adults in diverse settings.
  3. Encourage self-reflection: Train social workers to recognize and challenge their biases through critical reflection and discussion.

Conclusion

This systematic review underscores the importance of understanding and addressing ageism in social work. While significant progress has been made in measuring explicit and other-directed ageism, further research is needed to explore implicit and self-directed biases. By adopting a more comprehensive approach to studying ageism, social work as a profession can better advocate for older adults, ensuring equitable and respectful treatment in all areas of practice.

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Creating Elder-Friendly Communities: Preparing for an Aging Society

As the population ages, the need for communities to adapt to the changing requirements of older residents has become increasingly crucial. With the Baby Boomer generation entering retirement, a significant portion of society will soon be over the age of 65. By 2020, it was estimated that one in five Americans would be classified as senior citizens. This demographic shift brings both opportunities and challenges, necessitating the development of elder-friendly communities where older adults can live independently while remaining actively engaged in society.

An elder-friendly community is one that values and supports its older residents by providing necessary infrastructure, services, and opportunities that accommodate their evolving needs. Many communities today were not designed with the elderly in mind, and without appropriate modifications, aging in place can become difficult. This article explores what constitutes an elder-friendly community, the challenges involved in creating such environments, and the role of social workers and policymakers in facilitating these changes.

The Importance of Community Environment for Older Persons

Aging in place—the ability of individuals to remain in their own homes as they age—is a priority for the majority of older adults. Research has shown that over 80% of seniors prefer to stay in their homes for as long as possible. However, many homes and communities present barriers that make independent living difficult. Physical limitations can make daily activities such as driving, shopping, and home maintenance more challenging, increasing reliance on social services and caregiver support. Additionally, unsafe neighborhoods, inaccessible public buildings, and inadequate transportation can contribute to the isolation of older residents.

A well-designed elder-friendly community, on the other hand, actively promotes the well-being of its older residents. It ensures accessibility, offers social engagement opportunities, and integrates health and support services into the fabric of everyday life. A well-integrated support system can also alleviate the burden on family caregivers, reducing stress and preventing burnout. By addressing these issues, communities can empower older adults to contribute meaningfully to society while maintaining their independence.

Characteristics of an Elder-Friendly Community

While there is no universal definition of an elder-friendly community, research has identified several core characteristics that make a community more accommodating for older residents. Surveys and studies conducted by organizations such as AARP and various social research institutions highlight key features that contribute to community elder-friendliness, including:

  • Accessible and affordable transportation: Public transit should be senior-friendly, with features such as low-floor buses, special transport services, and well-maintained sidewalks and pedestrian crossings. Rideshare services and volunteer-driven transportation programs can also be beneficial.
  • Diverse housing options: A range of affordable housing options should be available, including single-story homes, assisted living facilities, and housing that incorporates universal design principles. Home modification programs should be in place to assist seniors in making their homes more accessible.
  • Responsive health and long-term care services: Health services should be easily accessible and include home-based care options, geriatric specialists, and community-based health initiatives. Preventative care and wellness programs should be readily available to ensure seniors maintain their health for as long as possible.
  • Safety and security: Communities should implement measures to ensure safety for older adults, such as well-lit streets, emergency response systems, and crime prevention programs tailored to seniors. Local law enforcement should work closely with senior advocacy groups to prevent elder abuse and scams targeting older individuals.
  • Social integration and respect for seniors: Elder-friendly communities should encourage active participation by older residents through volunteer opportunities, senior centers, and intergenerational programs that promote respect and engagement. Public spaces should be designed to encourage socialization and community events should be inclusive of older adults.

While these general characteristics provide a foundation for elder-friendly communities, individual communities may need to focus on different priorities based on their demographics and urban or rural settings. For instance, rural communities may need to prioritize transportation and healthcare access, while urban areas may need to focus on affordable housing and public safety.

Assessing and Planning for Elder-Friendliness

Creating an elder-friendly community requires a structured approach that involves assessing current conditions, identifying gaps, and planning for improvements. Needs assessments are a crucial first step in this process, as they help policymakers and social workers understand the specific challenges faced by older residents. These assessments can take both qualitative and quantitative approaches, such as focus groups, interviews, and surveys.

Several assessment tools have been developed to help communities evaluate their elder-friendliness, including:

  • The AARP Livable Communities Guide, which provides a checklist of factors affecting older residents.
  • The AdvantAge Initiative, which measures key indicators such as transportation availability, safety, and community involvement.
  • Elder Ready Community Report Cards, which help communities evaluate their accessibility and preparedness for an aging population.

Using these tools, local governments, nonprofit organizations, and community groups can identify necessary changes and develop strategies to enhance elder-friendliness. These assessments can also be used to track progress over time, ensuring continuous improvement in community services and infrastructure.

Examples of Elder-Friendly Initiatives

Several cities and regions have successfully implemented policies and programs to become more elder-friendly. For instance, the City of Pasadena developed a Senior Master Plan that analyzed senior needs, services, and policy recommendations. The plan, which included input from residents, agencies, and local government, resulted in expanded senior services, improved transportation options, and a greater focus on affordable housing.

Another example is the “Coming of Age in Rural Illinois” project, which conducted assessments to identify key issues faced by seniors in rural communities. By leveraging partnerships with local governments and service providers, the project was able to address transportation challenges and enhance community support networks.

Such initiatives demonstrate the importance of a lead organization in bringing together stakeholders, conducting assessments, and implementing meaningful changes that benefit older residents. Collaboration between public agencies, private organizations, and community groups is essential for sustained progress in developing elder-friendly environments.

The Role of Social Workers in Developing Elder-Friendly Communities

Social workers play a critical role in advocating for and supporting elder-friendly community initiatives. Their involvement includes:

  • Community assessment and advocacy: Social workers help identify areas where improvements are needed and advocate for policies that support aging in place.
  • Service coordination: They connect older adults with resources, including transportation, healthcare, and social services, to enhance their quality of life.
  • Policy development: Social workers can influence local planning and development efforts by ensuring that older residents’ needs are considered in housing, transportation, and healthcare policies.
  • Empowerment and education: They work to empower seniors by providing them with information and opportunities to voice their concerns in community planning processes.

Implications for Social Work

Social work plays a crucial role in fostering elder-friendly communities, as professionals in the field are uniquely positioned to advocate for aging populations, bridge gaps between services, and address systemic issues that affect older adults. Social workers must actively engage in community planning efforts to ensure that policies and programs meet the needs of aging residents. By promoting interdisciplinary collaboration between urban planners, healthcare providers, and policymakers, social workers can help create environments that support aging in place. Additionally, they play a key role in providing direct support, ensuring that older adults have access to essential resources such as affordable healthcare, transportation, and social services. Beyond advocacy and service coordination, social workers also empower older individuals through education and community engagement, encouraging them.

Implications for Practice

Developing elder-friendly communities requires a multifaceted approach that integrates policies, services, and infrastructure improvements. Practitioners in social work, urban planning, and public health must work together to create age-inclusive environments that support independence and social engagement. This means incorporating age-friendly design principles into urban development, expanding access to essential services, and fostering community programs that encourage intergenerational interaction. Furthermore, practitioners must ensure that the voices of older adults are heard in policy discussions, promoting participatory planning processes that reflect the real needs of aging residents. By embedding elder-friendly initiatives into broader community planning and public policy frameworks, practitioners can help establish sustainable, long-term improvements that benefit not only older adults but the entire community.

Conclusion

The aging population presents both challenges and opportunities for communities. By developing elder-friendly communities, local governments and service providers can ensure that older adults can continue to live safely, independently, and actively engaged in society. Key strategies include improving transportation, housing, healthcare, and community involvement opportunities.

While much progress has been made in recognizing the importance of elder-friendly communities, there is still work to be done. Needs assessments, policy changes, and community engagement efforts must continue to evolve to address the unique and changing needs of aging populations. Social workers, policymakers, and community organizations must collaborate to create supportive environments that enhance the well-being of older adults while enriching the broader community.

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Inspiring Hope Through Social Work Practice

Hope is a fundamental and dynamic force within social work practice, offering both clients and practitioners a means to navigate adversity and envision a better future. It serves as a crucial psychological and emotional mechanism that allows individuals to maintain a sense of purpose and direction in the face of hardship. Social work, as a discipline, fundamentally aligns with the promotion of hope, emphasizing empowerment, self-determination, and resilience. Despite its frequent mention in social work literature, the concept of hope remains ambiguously defined and under-theorized. The need to articulate a clearer framework for understanding and applying hope in social work practice is essential, as it can significantly influence intervention strategies and client outcomes. This article explores the role of hope in social work, analyzing its conceptual framework and practical applications while addressing its implications for research, direct practice, and professional education.

The nature of hope is multifaceted, often described as a cognitive, emotional, and relational process that enables individuals to persist through hardships. It is shaped by both intrinsic factors, such as personal experiences and beliefs, and extrinsic factors, including social support and cultural influences. While many scholars emphasize its future-oriented and rational characteristics, others highlight its role as an instinctive or spiritual force that transcends individual cognition. Psychologist C. Richard Snyder’s theory of hope identifies two key components: agency (the motivation to achieve goals) and pathways (the strategies to reach them). This theory underscores the importance of goal-setting and problem-solving in fostering hope. However, more recent perspectives emphasize that hope is not merely an individual trait but a collective force influenced by social and cultural contexts. Hope can be cultivated through communal support, shared narratives, and collective resilience, making it an integral component of social work interventions at both the individual and systemic levels.

Hope is ‘essential quality in social work’ – Collins (2015)

In the field of social work, hope serves as a transformative tool that fosters resilience, well-being, and recovery. It provides individuals with the motivation to seek help, adapt to difficult circumstances, and maintain a sense of optimism despite adversity. It is particularly significant for individuals coping with terminal illness, mental health challenges, and social marginalization. Studies have shown that instilling hope can enhance psychological resilience, reduce symptoms of anxiety and depression, and improve overall quality of life. Hope-oriented interventions have been linked to better outcomes for individuals facing extreme adversity, such as refugees, survivors of trauma, and those experiencing homelessness. Additionally, social work interventions that emphasize hope have been linked to better outcomes for refugees, trauma survivors, and individuals experiencing extreme adversity. By helping individuals find meaning and purpose, social workers can create environments where hope thrives, facilitating positive behavioral and emotional changes that contribute to long-term well-being.

Social workers operationalize hope through various relational and strengths-based practices. These approaches include role modeling, narrative therapy, group work, and solution-focused interventions that help individuals identify their strengths and set achievable goals. By fostering a hopeful perspective, social workers encourage clients to view challenges as opportunities for growth rather than insurmountable obstacles. In clinical settings, social workers often assist clients in redefining hope, particularly when facing chronic illness or disability. Rather than framing hope solely around unrealistic expectations of recovery, practitioners help clients cultivate hope in ways that align with their realities, offering reassurance without fostering denial. This nuanced approach ensures that hope remains a motivating force without becoming a source of false optimism. Through compassionate and client-centered interactions, social workers build trusting relationships that serve as the foundation for meaningful and lasting change.

From a strengths perspective, ‘a focus on the dreams, hopes, and visions of people encourages them to begin thinking subjunctively about what might be and how it might come about’ (Saleebey, 2000: 133; see also Saleebey, 2013).

Children and young people, particularly those in marginal situations, require distinct approaches to hope-building. Adolescents facing socioeconomic hardships, family instability, or mental health issues often struggle to maintain a hopeful outlook on their future. Social work research highlights that youth develop hope through social support, meaningful relationships, and engagement with their environment. By creating safe spaces where young people can explore their aspirations and strengths, social workers empower them to take control of their narratives and envision positive futures. For marginalized young people, hope often emerges through resistance and aspirations that challenge systemic oppression. Thus, social workers must navigate the complexities of hope, recognizing that it may manifest in unconventional ways, including dystopian perspectives in response to trauma and disenfranchisement. By integrating creative and culturally responsive interventions, social workers can facilitate hope-building experiences that foster self-efficacy, motivation, and resilience among young individuals who might otherwise feel powerless in their circumstances.

For social workers themselves, maintaining hope is essential to sustaining their practice. Working in environments characterized by systemic barriers, high caseloads, and emotionally taxing situations can take a toll on a practitioner’s well-being. Burnout and compassion fatigue can erode practitioners’ sense of hope, making self-care, supervision, and professional support critical components of social work. A hopeful organizational culture, coupled with a strengths-based educational framework, can reinforce social workers’ commitment to change and social justice. By fostering a professional environment that prioritizes emotional resilience and peer support, organizations can enhance social workers’ capacity to maintain their own sense of hope while empowering their clients. Additionally, reflective practices such as mindfulness, ongoing education, and engagement in social activism can help practitioners reconnect with their core values and sustain their passion for social work.

‘If we want the best for our clients, then the well-being and best interest of the workers needs to be considered … to instill hope in others one must have a sense of their own hope’ – McCarter (2007)

The conceptual framework presented in this article positions social work relationships as sites of hope. It suggests that hope is not an abstract ideal but a concrete, relational process shaped by critical reflection, cultural sensitivity, and social justice imperatives. Social work relationships provide a crucial space where individuals can explore their aspirations, build resilience, and challenge social injustices. By integrating hope into social work practice, professionals can empower individuals and communities, fostering resilience and meaningful change. Moreover, social workers must be attuned to the broader socio-political landscape, advocating for policies and practices that create equitable opportunities for hope to flourish. Recognizing the intersectionality of hope with issues such as poverty, discrimination, and trauma enables social workers to address systemic barriers while promoting individual and collective empowerment.

Social work must continue to explore and document the mechanisms through which hope operates in practice. Future research should focus on developing evidence-based strategies for nurturing hope across diverse populations and contexts. Understanding how hope interacts with factors such as socioeconomic status, cultural identity, and mental health can inform more effective and inclusive interventions. Ultimately, social work is a profession deeply intertwined with hope, and embracing this dimension can enhance its transformative potential for both practitioners and those they serve. By making hope a central component of social work theory and practice, the profession can continue to inspire positive change and empower individuals to build brighter futures.

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Nutritional Social Work: A New Frontier in Social Justice

Nutritional social work is an emerging area within the field of social work that extends beyond food security and food justice. While these aspects remain crucial, nutritional social work emphasizes the quality and adequacy of nutrition as a critical factor in individual and community well-being. The profession of social work has long engaged with food-related issues, but there is a growing need to integrate nutritional concerns at all levels of practice, including policy, community engagement, and direct practice.

The concept of food security encompasses availability, accessibility, utilization, and stability of food. However, food security alone does not guarantee nutritional well-being. Nutritional security ensures that all individuals have access not only to sufficient food but to food that is nutritious and conducive to health. The intersection of food security and nutrition security is pivotal to addressing food justice issues. Social workers must consider how economic and geographic accessibility, cultural practices, and sustainability influence food justice efforts.

Historically, social workers have played a role in addressing food insecurity through policy advocacy, community organizing, and direct intervention. The profession has contributed to policy development aimed at reducing hunger and promoting equitable food distribution. Social work literature has shown a drastic increase in discussions around food insecurity since the 1950s, with strategies ranging from policy change to direct services like food distribution programs. For example, Canada Without Poverty (CWP) advocates for a national nutritious school food program, emphasizing the need for strong, rights-based policies to ensure healthy eating is accessible for all.

Community initiatives such as food banks, pantries, and soup kitchens have been longstanding responses to food insecurity, yet these interventions often fail to address underlying structural inequalities. Increasingly, social work practice is shifting toward systemic approaches that include sustainable food production, urban farming, and community gardens to enhance food sovereignty and nutritional access. Community gardens, in particular, have been instrumental in addressing food deserts—areas where fresh food is inaccessible—and food swamps, which are flooded with unhealthy food options. Vertical farming has also emerged as a sustainable urban agricultural practice that not only improves food security but fosters community engagement and reduces environmental impact.

At the policy level, social workers advocate for rights-based approaches to food security, pushing for policies that ensure access to nutritious food, support local agriculture, and promote living wages to improve affordability. Policies must be rooted in social justice and must challenge neoliberal economic structures that perpetuate food insecurity. Social workers have a role in shaping national and international policies that prioritize nutrition as a fundamental human right. For instance, advocating for food justice includes pushing for the integration of sustainable agricultural practices, addressing the impact of climate change on food systems, and supporting local food economies.

Community-based interventions are essential for addressing food deserts and food swamps, where access to fresh, healthy food is limited or non-existent. Initiatives like community gardens and vertical farming are gaining traction as they provide sustainable food sources, empower communities, and foster resilience. Social workers engaging in nutritional social work should facilitate these efforts, ensuring that they are inclusive and culturally appropriate. The psychological benefits of such community-led initiatives are also noteworthy, as they reduce the distress associated with food insecurity and promote mental well-being through social connection and empowerment.

Direct practice in nutritional social work involves incorporating nutritional considerations into social work assessments and interventions. This includes recognizing the connections between nutrition and mental health, chronic illnesses, and overall well-being. Research indicates strong correlations between poor nutritional quality and mental health disorders such as depression and anxiety. Social workers should collaborate with nutritionists and other health professionals to provide holistic interventions that consider dietary needs as part of comprehensive care plans. Addressing food insecurity through direct practice requires an understanding of the socio-political determinants of health and a commitment to equity and empowerment.

From a critical intersectionality perspective, food insecurity disproportionately affects marginalized communities, including Indigenous populations, racial minorities, and low-income individuals. Colonial and racist land policies have contributed to structural food insecurity, and social workers must engage in decolonizing food systems. Indigenous communities often face unique challenges related to food insecurity due to historical injustices, loss of traditional lands, and systemic marginalization. Efforts to improve nutritional security must prioritize participatory approaches that empower affected communities to define their own food needs and solutions, recognizing the importance of culturally relevant food systems.

Nutritional social work represents an expansion of the social work discipline into a vital yet often overlooked aspect of human well-being. By integrating nutritional considerations into social work education, research, and practice, the profession can play a transformative role in ensuring that all individuals have access to not only food but food that nourishes and sustains. As the field continues to evolve, social workers must advocate for systemic change while engaging in grassroots initiatives that promote nutritional justice for all. Social work education should incorporate nutritional security into curricula, emphasizing its relevance in direct practice, community development, and policy advocacy. Furthermore, a robust research agenda is needed to explore the impacts of nutritional interventions on social outcomes, thereby strengthening the evidence base for nutritional social work.

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The Camberwell Assessment of Need: Evaluating and Addressing Needs in Severe Mental Illness

The assessment and management of needs for individuals with severe mental illnesses (SMI) are pivotal to effective mental health care. The Camberwell Assessment of Need (CAN), developed in the 1990s, represents a significant step forward in addressing this challenge. The CAN is an instrument that assesses the complex mix of clinical, social, and practical needs faced by people with SMI, serving as a tool for care planning and service evaluation. It was designed in response to increasing recognition of the importance of needs assessments in health care, as emphasized by legislative frameworks such as the National Health Service and Community Care Act of 1990 in Britain.

Background and Development of the Camberwell Assessment of Need

The development of the CAN was driven by the realization that traditional approaches to assessing needs often fell short in comprehensiveness, usability, and inclusivity. Historically, definitions of “need” have varied across disciplines, creating confusion in mental health services. Models such as Maslow’s hierarchy of needs and Bradshaw’s taxonomy of need have offered frameworks, but their application to mental health care has often been inadequate. Existing tools tended to focus on measuring disabilities rather than identifying actionable, remediable needs.

The CAN was designed to address these gaps, guided by four core principles. First, the instrument recognizes that needs are universal, and while individuals with mental illnesses may have specific requirements, their fundamental human needs—such as housing, food, and social connections—are shared with others. Second, the CAN prioritizes identifying unmet needs, providing a foundation for specialized assessments where necessary. Third, it emphasizes practicality, ensuring that the tool is easy to use and accessible to professionals from diverse backgrounds. Lastly, the CAN values subjective perceptions of need, capturing perspectives from both patients and staff to ensure a holistic understanding.

In its final form, the CAN assesses 22 domains of need, ranging from basic necessities like accommodation and food to complex areas like psychological distress, intimate relationships, and safety. Each domain is evaluated using a structured approach, considering whether a need exists, the extent of informal support available, and the level of professional help provided. The tool was designed to be adaptable, with clinical and research versions tailored for different purposes.

Validation and Reliability of the CAN

Extensive research underpins the CAN’s design, ensuring its validity and reliability. Validation involved feedback from 50 mental health professionals, who confirmed its relevance and comprehensiveness. Input from 59 individuals with severe mental illnesses further reinforced its applicability. For example, patients identified accommodation as their most critical need, highlighting the importance of addressing social determinants of health in mental health care.

Reliability studies demonstrated strong inter-rater agreement, indicating consistency in the tool’s application across different raters. Test-retest reliability, while moderate for some domains, suggested that certain needs might change over time or be influenced by contextual factors. The tool’s ability to differentiate between met and unmet needs was particularly noteworthy, allowing for targeted interventions and personalized care plans.

One of the key strengths of the CAN is its dual perspective. While staff assessments often focus on observable issues like psychotic symptoms or self-care, patients may highlight subjective concerns, such as feelings of isolation or dissatisfaction with support. This dual approach not only ensures a comprehensive understanding of needs but also aligns with contemporary mental health care principles, which emphasize patient-centered care.

Applications and Impact of the CAN

The CAN has proven to be a versatile tool with applications in various contexts. Clinically, it supports the development of individualized care plans by identifying specific areas of need and monitoring changes over time. Its structured format ensures consistency in assessments while remaining adaptable to the unique circumstances of each patient.

In research, the CAN has become a valuable instrument for evaluating mental health services. By providing a standardized method for assessing needs, it allows for comparisons across different settings and populations, facilitating evidence-based improvements in care delivery. For instance, studies using the CAN have highlighted disparities in service provision, prompting efforts to address gaps in access and quality of care.

The tool’s adaptability extends to its use with diverse populations. While initially designed for individuals with severe mental illnesses, the CAN has been translated into multiple languages and adapted for groups such as children, older adults, and people with learning disabilities. Its modular structure also allows for the inclusion of additional domains, making it suitable for addressing emerging challenges in mental health care, such as digital inclusion or environmental sustainability.

Limitations and Future Directions

Despite its strengths, the CAN is not without limitations. The initial validation study was conducted at a single site, with a sample characterized by high levels of service contact and predominantly met needs. This raises questions about its generalizability to populations with more volatile or complex patterns of need, such as homeless individuals or those in rural areas.

Additionally, some domains of the CAN showed lower reliability in test-retest analyses, suggesting potential variability in perceptions of need over time. This highlights the importance of ongoing training for users and further refinement of the tool to enhance its reliability and sensitivity.

Future research should explore the CAN’s applicability in diverse settings and its potential to address systemic barriers to care. For example, integrating the CAN with digital health platforms could enhance its accessibility and facilitate real-time data collection and analysis. Efforts to engage patients and caregivers in the development of new modules could also strengthen its relevance and impact.

Broader Implications for Mental Health Care

The development and success of the CAN underscore the importance of structured, evidence-based approaches to needs assessment in mental health care. By providing a comprehensive framework for understanding and addressing needs, the tool exemplifies how research can inform practice and policy. Its emphasis on patient-centered care aligns with broader trends in health care, which recognize the value of empowering individuals to take an active role in their care.

As mental health care continues to evolve, tools like the CAN will play a crucial role in shaping services that are responsive to the needs of individuals and communities. By fostering collaboration between patients, providers, and policymakers, the CAN represents a model for how health care systems can promote equity, quality, and sustainability.

In conclusion, the Camberwell Assessment of Need is more than just a tool; it is a testament to the power of innovation in mental health care. Its comprehensive approach to assessing needs, coupled with its adaptability and usability, makes it a cornerstone of modern mental health practice. As the field moves toward more inclusive and personalized care, the CAN will undoubtedly remain a vital resource for improving outcomes and enhancing the lives of individuals with severe mental illnesses.

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Learning by Stealth: The Journey of Newly Qualified Social Workers in Hospital Contexts

Hospitals are multifaceted ecosystems where the fast-paced, multidisciplinary nature of care creates a challenging yet rewarding environment for professionals. For newly qualified social workers (NQSWs), navigating the hospital setting is a unique and demanding journey. This article, based on the research of Danielle Davidson and Rosalyn Darracott, delves into the experiences of these social workers as they transition from academic training to professional practice in hospitals. The findings reveal how organizational factors, professional expectations, and personal growth intersect, often compelling NQSWs to “learn by stealth” to adapt to their roles.

Social workers in hospitals occupy an essential but often ambiguous position. Their roles extend beyond the hospital walls, encompassing tasks like discharge planning, bereavement counseling, patient advocacy, and crisis intervention. Despite their contributions, the hospital environment frequently emphasizes the need for swift discharge and task efficiency, sidelining traditional social work values and holistic care approaches. For NQSWs, this reality starkly contrasts the idealized principles instilled during their university education.

Bridging the Gap Between Education and Practice

Entering the hospital setting is akin to being thrust into uncharted waters for many NQSWs. While university programs equip students with foundational skills and values, the practical realities of hospital work can feel overwhelming. Participants in this study likened the transition to “being hit by a truck,” highlighting the mismatch between theoretical preparation and the operational demands of healthcare settings.

The primary challenge for NQSWs lies in reconciling their values with the pressures of hospital practice. The fast-paced environment, organizational imperatives, and hierarchical nature of healthcare often demand a shift away from patient-centered care toward task-focused efficiency. This adjustment can be jarring, with some participants describing how their social work values initially “fell away” as they learned to perform their duties. Only with time and experience were they able to reconnect with these values and integrate them into their practice.

The Concept of “Learning by Stealth”

In the absence of structured learning opportunities, NQSWs frequently resort to covert methods of acquiring knowledge and skills. This phenomenon, termed “learning by stealth,” reflects the challenges of seeking guidance in an environment that prioritizes competence and efficiency. Social workers often avoid asking questions for fear of appearing unprepared, instead relying on observation, mimicry, and self-directed research to fill gaps in their understanding.

Mastering the language and culture of the hospital is a significant aspect of this process. For instance, social workers described Googling medical terms and diagnoses during meetings to avoid admitting their unfamiliarity. Similarly, they observed and emulated experienced colleagues, selectively adopting practices that aligned with their professional aspirations.

While learning by stealth demonstrates the adaptability and resilience of NQSWs, it comes with risks. Without open dialogue and mentorship, there is a danger of perpetuating suboptimal practices and neglecting critical reflection. As one participant noted, social workers risk becoming “sheep,” merely replicating the behaviors of their predecessors without questioning their validity.

Organizational Barriers to Professional Development

The hospital setting poses several organizational challenges that hinder the professional growth of NQSWs. Workload distribution often leaves recent graduates feeling overwhelmed, while more senior practitioners enjoy lighter responsibilities to accommodate administrative duties. The contractual nature of employment further compounds this issue, fostering job insecurity and competition among colleagues. For many NQSWs, the uncertainty of their positions influences their willingness to advocate for patients or invest in their professional development.

This precarious employment environment also affects the quality of supervision and support available to NQSWs. While managers recognize the importance of mentorship, the frenetic pace of hospital work often reduces supervision to operational matters, leaving little room for critical reflection or professional growth. Consequently, NQSWs must navigate their roles with limited guidance, relying on their resourcefulness to adapt to the complexities of their work.

Implications for Practice and Policy

The findings of this study underscore the need for more intentional support and socialization of NQSWs in hospital contexts. Structured programs like the Queensland Health Social Work New Graduate Programme, which aim to bridge the gap between education and practice, represent a step in the right direction. However, these initiatives must balance task-oriented training with opportunities for critical reflection and professional identity development.

Creating a culture of learning within hospitals requires addressing systemic issues such as workload distribution, job security, and supervisory practices. By fostering an environment where NQSWs feel safe to ask questions and engage in reflective dialogue, hospitals can empower social workers to align their practice with professional values and enhance patient care.

Conclusion

The journey of becoming a hospital social worker is fraught with challenges, particularly for those new to the profession. NQSWs must navigate the complexities of their roles while contending with organizational pressures and limited support. Yet, their resilience and adaptability shine through as they develop their skills and identities, often in unconventional ways.

To support this transition, hospitals must prioritize the professional development of NQSWs, providing them with the resources and mentorship needed to thrive. By doing so, they can ensure that social workers not only meet the demands of their roles but also uphold the values and principles that define their profession.

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Dopamine: The Neural Conductor of Addiction and Behavior

Dopamine, a neurotransmitter often associated with pleasure and reward, is central to understanding the mechanisms of addiction and behavioral learning. The interplay between dopamine’s signaling pathways, behavior, and the effects of addictive substances reveals a sophisticated neural orchestra that governs learning, motivation, and habit formation. The research by Roy A. Wise and Chloe J. Jordan intricately explores these dimensions, presenting a detailed portrait of how dopamine underpins addiction and other related behaviors.

Dopamine’s pivotal role in behavior stems from its dual firing modes: burst-firing and pacemaker-firing. These two firing patterns facilitate environmental learning and modulate motivational arousal, respectively. While burst-firing enables learning connections within the brain, pacemaker-firing regulates baseline motivational states. Understanding these mechanisms elucidates dopamine’s critical contributions to both natural and drug-induced behaviors.

Dopamine and Learning: The Foundation of Habitual Behavior

Learning is a cornerstone of behavior, heavily influenced by dopamine. Dopamine-deficient animals, which lack the neurotransmitter entirely, exhibit a striking inability to perform learned behaviors. These animals rely solely on unconditioned reflexes and fail to develop “appetitive” responses, such as seeking food or avoiding punishment. This inability underscores dopamine’s essential role in linking environmental cues to behavioral outcomes.

The process of learning in dopamine-rich systems is facilitated through burst-firing. This rapid discharge of dopamine neurons is triggered by stimuli associated with rewards or punishments. When dopamine neurons burst-fire, they enable the development of long-term potentiation (LTP) and long-term depression (LTD) in the striatum, the brain region responsible for integrating sensory inputs and coordinating motor outputs. This synaptic plasticity allows animals to adapt to their environments by forming and refining associations between stimuli and corresponding actions.

Predictive stimuli play a vital role in this learning process. For instance, dopamine neurons respond not only to rewards but also to cues that predict those rewards. Over time, the brain’s response shifts from the reward itself to its predictor, emphasizing the anticipatory nature of dopamine-driven learning. This transition involves Hebbian mechanisms, where repeated exposure to a predictive cue strengthens its association with the reward.

Motivation and Pacemaker-Firing: Regulating the Drive to Act

While burst-firing facilitates learning, pacemaker-firing governs the motivational arousal required to act on learned associations. In a resting state, dopamine neurons exhibit pacemaker-firing, characterized by steady, single-spike discharges. This firing mode is modulated by internal states, such as hunger or satiety, and external influences, such as hormonal signals.

Motivational arousal, regulated by pacemaker-firing, determines an animal’s readiness to respond to environmental cues. This state-dependent regulation ensures that animals prioritize behaviors aligned with their immediate needs. For example, a previously sated animal may exhibit increased responsiveness to food-related cues as hunger develops, driven by changes in pacemaker-firing rates.

Dopamine’s influence on motivation is not linear. Instead, it follows a U-shaped curve, where both low and excessively high levels of dopamine reduce motivation. Drugs like amphetamines and cocaine, which significantly elevate dopamine levels, can paradoxically impair motivation by pushing dopamine levels beyond optimal ranges.

Addiction and the Dopaminergic System

Addiction exemplifies the intersection of learning and motivation within the dopaminergic system. Addictive substances hijack the brain’s reward pathways, amplifying dopamine release and reinforcing drug-seeking behaviors. Different drugs interact with dopamine systems to varying degrees, highlighting the complexity of addiction.

Psychostimulants like amphetamines and cocaine exhibit strong dopaminergic effects, elevating dopamine levels by over fourfold. These substances induce pronounced synaptic changes in the striatum, solidifying the neural circuits associated with drug-seeking. Opiates such as heroin also rely on dopamine to sustain their reinforcing effects, with animals self-administering heroin to maintain dopamine levels above twice-normal baselines.

Nicotine, another highly addictive substance, triggers burst-firing in dopamine neurons and elevates dopamine levels. Nicotinic receptors on dopamine neurons play a crucial role in this process, with genetic modifications to these receptors significantly altering nicotine’s reinforcing properties.

Alcohol and cannabis, while also affecting dopamine systems, exhibit more complex interactions. For instance, alcohol increases dopamine levels and enhances synaptic plasticity, but its reinforcing effects may involve dopamine-independent pathways. Similarly, cannabis, through its active ingredient THC, influences dopamine turnover and reward processing, though its effects are less consistent across species.

Other substances, such as barbiturates, benzodiazepines, and caffeine, also engage the dopaminergic system to varying extents. These drugs induce dopamine release and modulate synaptic plasticity, contributing to their reinforcing properties.

Dopamine’s Dual Role: Reward and Aversive Conditioning

While dopamine is often associated with rewards, it also plays a role in aversive conditioning. Predictive cues for delayed or absent rewards can become aversive, highlighting the dynamic nature of dopamine’s influence on behavior. This dual role underscores the neurotransmitter’s broader function in encoding both positive and negative motivational signals.

Conclusion: A Blueprint for Future Research

Dopamine is central to understanding learned behavior, motivation, and addiction. Its role in facilitating LTP and LTD, modulating motivational arousal, and reinforcing drug-seeking behaviors provides a comprehensive framework for exploring the neural basis of behavior. However, significant gaps remain, particularly regarding the mechanisms through which different drugs interact with dopamine systems.

Future research should focus on comparing the abilities of various addictive substances to induce LTP and facilitate habit formation. Additionally, advancements in imaging techniques and optogenetics hold promise for unraveling the intricate dynamics of dopamine signaling. By deepening our understanding of dopamine’s multifaceted roles, we can pave the way for more effective interventions for addiction and other dopamine-related disorders.

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Social Work and the Challenge of Addiction

Addiction is a complex, multifaceted problem that has significant ramifications for individuals, families, and communities. It contributes to violent crime, loss of productivity, income inequality, and remains a leading cause of preventable death. Despite ongoing prevention and treatment efforts, the issue persists, revealing critical gaps in how addiction is understood and addressed. Social work, as a profession rooted in holistic, person-environment philosophies, has a pivotal role to play in addressing addiction. However, the field is currently underprepared to meet this challenge, largely due to inadequate academic training and an over-reliance on medical and individualistic paradigms. By examining alternative addiction theories, addressing gaps in social work education, and fostering interdisciplinary alliances, the profession can redefine its role in addiction treatment and prevention.

Addiction: A Multidimensional Challenge

Addiction is not merely a health issue but a societal one, deeply intertwined with social, economic, and psychological factors. It has been classified as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which acknowledges substance-related and behavioral addictions such as gambling. The inclusion of behavioral addictions underscores the broader scope of addiction’s impact, encompassing compulsive behaviors beyond substance use.

Social workers frequently encounter addiction in their practice across diverse settings, including child welfare, healthcare, education, and community programs. Studies reveal that 71% of employed social workers have addressed substance abuse issues in their professional roles. Despite this prevalence, many social workers lack the specialized training required to handle such cases effectively. This gap stems from an insufficient focus on addiction within social work curricula, which often relegates the topic to elective courses or ignores it entirely.

The dominant medical model of addiction, which conceptualizes it as a chronic disease characterized by compulsive behavior, has long shaped treatment approaches. While this model has contributed to advancements in pharmacological treatments and diagnostic criteria, it oversimplifies addiction by focusing primarily on individual pathology. This narrow perspective neglects the social determinants and relational dynamics that contribute to addictive behaviors. Social work, with its ecological and biopsychosocial frameworks, offers a more nuanced understanding of addiction as a symptom of broader systemic issues.

Alternative Theories Aligned with Social Work Principles

To address the limitations of the medical model, alternative theories have emerged that align more closely with social work’s holistic and relational orientation. Three such theories are the Dislocation Theory, Fragmented Intimacy Theory, and Congruence Couple Therapy (CCT). Each offers valuable insights into the systemic and contextual factors underlying addiction.

Dislocation Theory: Proposed by Bruce Alexander, this theory reframes addiction as a response to social dislocation—the erosion of meaningful human connections caused by societal and economic disruptions. According to Alexander, the modern free-market system has exacerbated social fragmentation, leading to widespread feelings of alienation and loss of identity. Addiction, in this context, serves as a coping mechanism for individuals grappling with dislocation. However, it ultimately fails to provide the depth of connection and meaning needed for long-term well-being. The theory advocates for systemic interventions aimed at restoring psychosocial integration, such as strengthening community ties and addressing structural inequalities. This perspective aligns with social work’s commitment to social justice and systemic change.

Fragmented Intimacy Theory: Developed by Peter J. Adams, this theory shifts the focus from individual pathology to relational dynamics. Addiction is conceptualized as a dominant relationship that displaces healthier social and familial connections. This fragmentation of intimacy often results in family deterioration and strained relationships. The theory emphasizes reintegration through strategies that restore and strengthen relational bonds. By involving families and communities in the treatment process, this approach addresses the relational ruptures that often underlie addiction. It also highlights the importance of culturally sensitive interventions, particularly for indigenous communities, where connectedness to family, land, and spiritual traditions is integral to healing.

Congruence Couple Therapy (CCT): Created by Bonnie K. Lee, CCT is a systemic, humanistic therapy that addresses addiction through a relational lens. It focuses on achieving congruence—the alignment of individuals’ internal experiences with their external expressions—across intrapsychic, interpersonal, intergenerational, and spiritual dimensions. CCT views addiction as an extreme form of alienation resulting from disrupted relationships and adverse experiences. By fostering congruent communication and repairing relational disconnections, CCT offers a pathway to healing that extends beyond symptom management. Empirical studies have demonstrated its efficacy in improving addiction symptoms, relational dynamics, and family functioning.

Bridging Gaps in Social Work Education

Despite the relevance of addiction to social work practice, the topic remains underrepresented in academic training. Most social work programs do not require courses on addiction, and accreditation standards often overlook this critical area. This deficiency leaves practitioners ill-equipped to address the complexities of addiction, undermining the profession’s potential contributions to this field.

Integrating addiction education into social work curricula is essential for preparing future practitioners. This includes courses on the neurochemistry of addiction, its social and relational dimensions, and the impact of adverse childhood experiences (ACEs). Specialized training programs, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT), have shown promise in enhancing social workers’ competence and confidence in addressing substance use issues. Furthermore, incorporating addiction training into licensing and continuing education requirements can ensure that practitioners maintain up-to-date knowledge and skills.

Forming Interdisciplinary Alliances

Given the multifaceted nature of addiction, interdisciplinary collaboration is crucial for developing effective interventions. Social work can form alliances with related disciplines, such as addiction counseling, family therapy, and public health, to create integrated approaches to treatment and prevention.

Addiction Counseling: Social work and addiction counseling share complementary strengths. While social work offers a systems-based perspective, addiction counseling often focuses on individual interventions. Combining these approaches can lead to more comprehensive frameworks that address both individual and systemic factors.

Family Therapy: Family therapy’s relational and systemic orientation aligns closely with social work values. Many of its foundational contributors, such as Virginia Satir and Michael White, were social workers. Collaborating with family therapists can enhance social work’s capacity to address addiction within relational contexts, emphasizing the role of families in recovery.

Public Health: Social work and public health share a common mission to address social determinants of health and promote population well-being. Collaborative efforts can focus on preventing addiction at the community level and formulating cohesive health and social policies. Public health frameworks can also inform social work interventions by highlighting the structural factors that contribute to addiction.

Addressing Systemic Factors

Beyond individual and relational dynamics, social work must engage with broader systemic issues that contribute to addiction. Adverse childhood experiences, poverty, racial inequality, and other forms of marginalization are significant risk factors. Social work’s focus on social justice and advocacy positions it to address these root causes, emphasizing prevention and early intervention.

Religion and spirituality also warrant greater attention in social work’s approach to addiction. While spiritual practices can provide resilience and meaning, they must be integrated thoughtfully to avoid reinforcing oppressive or exclusionary dynamics. Culturally sensitive interventions that honor diverse spiritual traditions can enhance the effectiveness of addiction treatment.

A Call to Action

The field of social work stands at a crossroads in its approach to addiction. By embracing alternative theories, enhancing education, and fostering interdisciplinary collaboration, the profession can redefine its role in addressing one of society’s most pressing challenges. Addiction is not merely a disease to be treated but a symptom of deeper social and relational fractures. Addressing it requires a holistic, systemic perspective that aligns with social work’s core values. Through these efforts, social work can not only contribute to more effective addiction interventions but also advance its mission of promoting social justice and human well-being.

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The Role of Social Work in Mental Health: Insights from Service Users

Social work has always occupied a vital position within mental health care, yet its specific contributions remain underexplored and frequently misunderstood. As debates over its unique value persist, understanding the perspectives of service users—those directly impacted by social work—is crucial. A recent study led by a collaborative team of academics and individuals with lived experience aimed to uncover what service users value most in mental health social work. By employing Best-Worst Scaling (BWS), the study provided a quantifiable understanding of service user preferences for ten key attributes of social workers. The findings shed light on both the profession’s strengths and areas requiring improvement, offering a roadmap for enhancing social work’s role in mental health.

The Importance of Continuity of Care

The study’s most striking finding was the overwhelming emphasis placed on relational continuity. Service users consistently ranked having a reliable and continuous point of contact as the most critical attribute of mental health social workers. This finding resonates with broader concerns about the frequent disruptions in care caused by staff turnover or system fragmentation. Many participants expressed frustration at having to retell their personal histories to new social workers, describing the process as exhausting and dehumanizing. Beyond practical inconveniences, these disruptions eroded trust and hindered the development of meaningful therapeutic relationships.

“The research finds the overriding concern amongst service users was that their social worker must provide a continuous and reliable source of support.”

The implications for mental health services are profound. While policy initiatives have focused on achieving continuity across service transitions, the relational aspect of care—ensuring that the same professional provides consistent support—remains elusive.

“Qualitative data unequivocally highlight the negative implications of interruptions to relational continuity. Partly this forms a frustration of having to ‘tell my whole life story again and again’ after ‘being thrown around backwards and forwards between different social workers’ (interviewee in Biringer et al., 2017, p. 7). Similarly, unreliable practitioners who miss appointments or do not deliver what is agreed can add to a sense of anxiety that can already accompany receipt of mental health services (Biringer et al., 2017).”

National studies have highlighted the scale of this issue, with many service users experiencing multiple changes in care coordinators within a year. Such instability not only undermines the effectiveness of care but also exacerbates the emotional strain on individuals already grappling with mental health challenges. Addressing this gap requires systemic changes, including workforce retention strategies and policies that prioritize long-term relational continuity.

Holistic Approaches: Seeing Beyond the Illness

Another highly valued attribute identified in the study was the ability of social workers to consider the whole person rather than focusing solely on their mental health condition. This aligns with the social model of mental health, which emphasizes the interplay between social, economic, and environmental factors in shaping an individual’s well-being. Service users appreciated social workers who demonstrated an interest in their broader life circumstances, such as housing, employment, relationships, and community engagement.

This holistic perspective is particularly significant given the widespread social disadvantages faced by individuals with mental health conditions. Many service users encounter systemic barriers, including poverty, discrimination, and social exclusion, which compound their challenges. By addressing these underlying issues, social workers can empower individuals to pursue recovery in a way that is both sustainable and meaningful. The study’s findings reinforce the importance of this approach, positioning social workers as uniquely equipped to bridge the gap between clinical interventions and broader social support.

The Role of Advocacy and Rights Protection

Protecting rights and entitlements was another attribute that service users valued, particularly among male participants. Social workers’ ability to advocate for fair treatment, ensure access to benefits, and navigate complex systems of entitlements was seen as an essential component of their role. For many, this advocacy represented a lifeline, particularly in contexts where individuals felt marginalized or overwhelmed by bureaucratic processes.

However, the study also revealed a potential disconnect between the importance of this role and its visibility to service users. While advocacy is a cornerstone of social work practice, its benefits are not always effectively communicated. Ensuring that service users understand and appreciate the significance of these efforts may enhance their overall perception of the profession’s value.

Challenges in Arranging Access to Services

Interestingly, the study found that arranging access to other services was among the least valued attributes. This may appear surprising given the emphasis on holistic care. However, the finding likely reflects deeper issues, including skepticism about the effectiveness of external resources and a lack of trust in the broader system. Service users with longer histories of mental health support were particularly dismissive of this attribute, suggesting that past experiences may have left them disillusioned.

This finding raises important questions for the profession. Are social workers adequately involving service users in decisions about referrals and external support? Is there a need for greater transparency about how these activities contribute to recovery? Addressing these questions could help rebuild trust and ensure that service users perceive liaison activities as beneficial rather than detached from their immediate needs.

Tailoring Support to Diverse Needs

The study also highlighted significant variations in preferences based on demographic factors. For example, younger participants and those newer to mental health services placed a higher value on non-judgmental attitudes, suggesting that they may be more sensitive to perceived biases or stigma. Conversely, older participants and those with extensive experience in the mental health system appeared more desensitized to professional judgment, prioritizing other attributes instead. Similarly, men valued rights protection more than women, potentially reflecting traditional gender roles in managing financial and legal matters.

These findings underscore the importance of personalized approaches in social work. By understanding the unique needs and priorities of different service user groups, social workers can tailor their practices to provide more effective and meaningful support.

Systemic Barriers and Professional Challenges

While the study illuminated key areas of value, it also highlighted systemic barriers that hinder the profession’s ability to meet these expectations. Continuity of care, for instance, is often beyond the control of individual social workers, shaped instead by organizational policies and resource constraints. High caseloads, staff shortages, and the pressures of multidisciplinary working environments further complicate efforts to provide consistent and personalized support.

Moreover, the study’s findings point to a broader issue of professional identity. Despite its distinct focus on social determinants and empowerment, social work’s role in mental health is often perceived as “invisible” or secondary to clinical professions. This lack of clarity not only affects how the profession is valued but also contributes to job dissatisfaction among social workers themselves.

Implications for Practice and Policy

The findings of this study offer several actionable insights for the profession. First, they underscore the need to prioritize relational continuity in mental health services. While achieving this requires systemic changes, individual social workers can play a role by advocating for smoother transitions and maintaining strong relationships with service users during periods of change.

Second, the study highlights the value of holistic, person-centered approaches. Social workers should continue to emphasize their unique ability to address the broader social and environmental factors affecting mental health, using this as a cornerstone of their professional identity. Clear communication about the benefits of these approaches can also enhance service users’ understanding and appreciation of social work.

“The second most valued attribute, and the most unique to social work according to the expert panel, was attention paid to ‘my whole life, not just my illness’.”

Finally, the findings call for a re-evaluation of how social workers engage in liaison activities. Greater involvement of service users in these processes, combined with efforts to rebuild trust in external resources, could make this aspect of social work more effective and valued.

Conclusion

This research provides a compelling case for centering service users’ voices in shaping the future of mental health social work. By identifying and prioritizing the attributes most valued by service users, the profession can refine its practices and strengthen its unique contributions to mental health care. At its core, social work is about relationships, empowerment, and holistic care—qualities that service users recognize and deeply value. However, achieving these ideals requires addressing systemic barriers, enhancing professional clarity, and fostering a culture of co-production that places service users at the heart of decision-making. In doing so, social work can not only meet the needs of those it serves but also reaffirm its essential role in mental health services.

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Addressing Self-Harm: Assessment, Management, and Prevention

Introduction
Self-harm, defined as intentional self-poisoning or injury irrespective of intent, remains a significant public health issue affecting individuals across all age groups and demographics. The behavior is often associated with underlying mental health conditions, emotional distress, or adverse social circumstances. To address this, the National Institute for Health and Care Excellence (NICE) released guideline NG225, offering evidence-based recommendations for assessing, managing, and preventing recurrence of self-harm. This article delves deeply into the key aspects of the guideline, designed for healthcare professionals, educators, social care practitioners, and others involved in supporting those who self-harm.

Understanding Self-Harm
Self-harm includes a wide range of behaviors, such as cutting, poisoning, or other acts of self-injury, that are intentional but may not always be intended to end life. Unlike stereotypical self-injurious behaviors seen in some developmental disorders, self-harm in this context often arises from emotional dysregulation, mental health disorders, or environmental stressors. It requires a holistic understanding that respects individual circumstances and avoids stigmatization.

Core Principles of Care
Providing care for individuals who self-harm must be grounded in respect, dignity, and empathy. Practitioners are encouraged to address the stigma surrounding self-harm and to adopt a collaborative approach with patients and, when appropriate, their families or carers. This collaboration should focus on shared decision-making, enabling individuals to have control over their care plans and fostering a sense of empowerment. Special attention should be given to inclusivity, ensuring care strategies are adapted to meet the needs of underserved or marginalized populations, such as those with disabilities, neurodevelopmental disorders, or from minority ethnic and LGBTQ+ backgrounds.

Assessment and Psychosocial Care
Timely and thorough psychosocial assessments are crucial in understanding the context of self-harm and addressing underlying issues. Mental health professionals should prioritize building a therapeutic relationship with the individual, exploring the functions and reasons for their self-harming behavior. Assessments should be conducted in private settings that promote confidentiality and are sensitive to the individual’s preferences and needs.
Key considerations include:

  • Assessing the individual’s emotional and mental state, social circumstances, and immediate safety.
  • Understanding the specific triggers and personal values associated with the behavior.
  • Tailoring assessments for specific populations, such as children, older adults, and individuals with learning disabilities, ensuring age-appropriate and context-sensitive approaches.
    For children and young people, professionals should explore social, educational, and home environments while addressing potential safeguarding concerns. In older adults, factors such as loneliness, cognitive impairments, and physical health issues should be prioritized.

Prevention Strategies and Interventions
Preventing self-harm recurrence requires a multi-faceted approach that combines psychological support, safety planning, harm minimization, and coordinated care across services. Psychological interventions, particularly those informed by cognitive-behavioral therapy (CBT), are the cornerstone of treatment for individuals who self-harm. For children and adolescents experiencing emotional dysregulation and frequent self-harming episodes, dialectical behavior therapy adapted for adolescents (DBT-A) is recommended.
Collaboratively developed safety plans are integral to prevention. These plans should help individuals identify triggers, develop coping mechanisms, and access support during crises. Safety measures may include removing access to means of self-harm and providing practical tools for managing distress. Harm minimization strategies, such as education on wound care and safe practices, can also play a role when individuals are not yet ready to completely stop self-harming.
Safer prescribing is critical in minimizing risks for individuals at high risk of overdose. This involves reviewing medications, limiting quantities, and maintaining open communication with other healthcare providers. Pharmacological interventions, however, are not recommended as primary treatments for self-harm.

Role of Professionals in Various Sectors
Healthcare professionals, educators, and staff in social and criminal justice settings all play vital roles in supporting individuals who self-harm.
Healthcare settings must adopt integrated care models that bring together mental and physical health services. Emergency departments should ensure access to private spaces for assessments, maintain clear protocols for managing frequent attenders, and prioritize collaborative decision-making. Schools and educational institutions should have designated leads for mental health who ensure the implementation and regular review of self-harm policies. These policies should provide guidance on identifying self-harming behaviors, supporting affected students, and addressing the needs of their peers.
In criminal justice settings, staff should be equipped to identify and respond to self-harm, ensuring access to appropriate healthcare and safeguarding resources. Secure environments, such as immigration removal centers, must address the heightened risks of self-harm and suicide among their populations while providing staff with adequate support for their own mental well-being.

Training and Supervision
The guideline underscores the importance of regular training for all professionals working with individuals who self-harm. This training should address the psychological and emotional complexities of self-harm, cultural competency, de-escalation techniques, and the development of compassionate communication skills.
Staff in specialist roles, such as mental health professionals, should receive additional training in conducting psychosocial assessments and risk formulation. Regular supervision and emotional support for staff are essential to help them manage the challenges associated with working in this field, ensuring they can provide compassionate and effective care without burnout.

Conclusion
The NICE guideline NG225 provides a comprehensive framework for addressing self-harm through respectful, evidence-based care. By prioritizing timely assessments, tailored interventions, and collaborative prevention strategies, professionals can significantly improve outcomes for individuals who self-harm. This requires coordinated efforts across healthcare, education, and social sectors, supported by ongoing training and robust policies. Ultimately, fostering a culture of understanding and compassion is crucial in reducing the prevalence and impact of self-harm while ensuring that affected individuals receive the support they need to recover.

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