What do BSW graduates need to know about mental health?: educational insights derived from integrating service-users’, students’, and academic-educators’ perceptions

ABSTRACT

This study aims to support curriculum development by integrating service-users’, students’, and academic educators’ perspectives regarding the mental health knowledge Bachelor of Social Work (BSW) students should possess upon graduation. Set in the Israeli context, thirty-nine semi-structured interviews were conducted with ten service-users, ten academic-educators, ten BSW, and nine Master of Social Work (MSW) students. Data were analyzed using inductive thematic analysis. Analysis revealed three major themes: 1. Person-centered approach—A humane, non-patronizing, relationship-based approach forms the foundation of mental health practice 2. Negotiating the role of bio-medical knowledge—Contributions and perils of bio-medical knowledge to social work education and practice. 3. Mental health knowledge broadened—Additional topics valuable to BSW graduates’ knowledge, such as knowledge about service-users’ experiences, recovery approach, and critical mental health. The discussion presents four educational-insights derived from the findings: 1. Articulate recovery as the mental health framework for person-centered approach. 2. Teach bio-medical knowledge from a person-centered holistic perspective. 3. Ground person-centeredness in a socio-political context. 4. Involve service-users and practitioners in academic education. These insights are discussed in the context of current debates in social work education, such as person-centeredness, service-user involvement, and neo-liberal individualization.

KEYWORDS:

• Mental health
• person-centered
• service-user involvement
• experts by experience
• curriculum design
• recovery
• bio-medical approach
• social-justice
• neo-liberalism
• social-work students
• lived experience in mental health

Introduction

Mental health is a prominent and persistent global (World Health Organization[WHO], 2022) and Israeli (Moran et al., 2016) concern. Positioned in a wide array of roles in social and health services as well as in the non-government and private sectors, social workers are central in addressing the mental health concerns of diverse service-user groups, even when not directly working in the mental health system (McCusker & Jackson, 2016; Northern Ireland Department of Health, 2019). In this context, and while acknowledging that many social workers pursue further education, BSW graduation serves as the entry point to full-fledged professional social work roles and service provision to people with mental conditions (McCusker & Jackson, 2016). Thus, there is pressing need for social work education to provide BSW students with mental health knowledge to prepare them for practice (McCusker & Jackson, 2016; Whitaker et al., 2022).

This study adopts Drury Hudson’s (1997, p. 37) definition of professional social work knowledge as:

The cumulated information or understanding derived from theory, research practice or experience considered to contribute to the profession’s understanding of its work and that serves as a guide to its practice.

This definition overlaps with other typologies of social work knowledge (most notably: Trevithick, 2008). However, we find Drury Hudson’s (1997) definition to account for social work knowledge’s multifaceted and action-oriented nature in the clearest and most parsimonious way.

As a profession, social work emphasizes participatory practice and collaboration with service-users (International Federation of Social Workers [IFSW], 2018). Service-user involvement in social work education is now a worldwide phenomenon (Adamson et al., 2022). Additionally, there is growing acknowledgment that many students and educators have significant lived-experiences of mental health, influencing how they learn and teach (Fox, 2016; Weerman & Abma, 2019). Furthermore, social work education shows increased interest in enhancing students’ engagement and active participation in the educational process (Rodriguez-Keyes et al., 2013). Recent advances in higher education scholarship, policy, and practice point to a more radical shift toward a model of ‘students as partners’ in which students and educators collaborate ‘in the quality enhancement of learning and teaching practice and policy’ (Healey et al., 2014, p. 23), including curriculum design. Nevertheless, Reith-Hall (2020, p. 9) claims that: ‘Involving students in curriculum design and delivery is at an embryonic stage in social work education’.

These participatory approaches highlight the need to account for different stakeholder perspectives when constructing the social work curriculum (Burgess, 2004). Yet, in an inquiry into their experiences and priorities as social work mental health educators in Australia, Whitaker et al. (2022, pp. 9–10) claimed that:

The scope of mental health content is dependent upon the preferences of individual social work academics and their perceptions of teaching and learning priorities, rather than practice wisdom and research in this field.

This seems to be the case not only in Australia (Kourgiantakis et al., 2022).

The current study addresses the need to account for different stakeholder perspectives by integrating academic-educators’, service-users’, and students’ views about mental health knowledge BSW students should acquire during their academic education.

Stakeholders’ perspectives regarding BSW students’ mental health knowledge

Academic educators

Academic educators describe a tension between educating students according to social work’s value-base and preparing students to practice (Dewees & Lax, 2008; Sapouna, 2016; Whitaker et al., 2022). Educators stress their commitment to holistic and recovery-oriented mental health education aligned with transformative paradigms such as critical theory and social justice (Whitaker et al., 2021). Within these perspectives, social workers are not considered experts who hold knowledge about and power over service-users. Rather, they are partners who ‘stand by’ service-users supporting them in promoting individual and collective goals (Karban, 2017; Krumer-Nevo, 2016; Whitaker et al., 2021). Nevertheless, educators also voice concern that the focus on transformative paradigms may not prepare students for practice in a bio-medical dominated field, heavily influenced by neo-liberal tendencies, where professional expertise are valued over experiential ones (Dewees & Lax, 2008; Sapouna, 2016; Whitaker et al., 2022). The tension between social work values and preparing students to practice is also reflected in a survey conducted in the US assessing educators’ views about the Diagnostic and Statistical Model of Mental Disorders (DSM) as a component of the mental health curriculum (Lyter & Lyter, 2016 - We acknowledge that the International Classification of Diseases [ICD] is used in other jurisdictions). Lyter and Lyter (2016) found that while only 34% of educators sampled believed that the DSM is sensitive to a person-in-environment perspective, 75% agreed that DSM content is necessary to BSW mental health social work education, with 93% claiming that BSW graduates should gain ‘basic understanding’ of DSM content.

Service-users

The last 30 years have seen the growing involvement of service-users in social work education (Adamson et al., 2022; Stanley & Webber, 2022). Service-user involvement is endorsed by the ‘Global Standards for Social Work Education and Training’ (International Association of Schools of Social Work & International Federation of Social Workers [IASSW & IFSW], 2020). In the UK, service-user involvement is mandatory in all aspects of student education (Social Work England, 2021). However, despite many inspiring collaborations, service-user involvement is still far from embedded in social work education (Howells et al., 2022; Lonbay et al., 2022; Mahboub et al., 2022). Furthermore, tokenism, co-optation, and professional control over service-users’ voice constitute significant threats to meaningful and transformative service-user involvement (Sapouna, 2016; Voronka & Grant, 2022).

People with lived experiences of mental health conditions are a significant group involved in student education (Adamson et al., 2022; Stanley & Webber, 2022). However, despite their growing involvement, little is known about service-users’ perspectives on BSW students’ mental health knowledge. Some insights can be gleaned from the accounts and motivations of service-users participating in student education. For example, Schön (2016) found that service-users believed that providing students with knowledge about their experiences of illness, recovery and receiving services from social workers will improve social workers’ comprehension of the subjective experiences of mental health and, subsequently, their practice. Other service-users, such as June Saad, highlight the need for students to embrace critical thinking and transformative practice: ‘One of the challenges for the future is supporting students’ development in maintaining anti-oppressive individual practice whilst working in increasingly oppressive organizational and institutional structure’ (Baldwin & Sadd, 2006, p. 358).

Further insights can be gained from studies addressing service-users’ perspectives regarding the desired qualities of mental health services and practitioners. These studies show that service-users value practitioners who adopt a person-centered holistic approach while investing in building continuous, non-judgmental, supportive, and collaborative relationships (Ljungberg et al., 2015; Trevillion et al., 2022). Similar findings were found in a recent study examining service-users’ ratings of the desired qualities of mental health social workers (Wilberforce et al., 2020). These valuable insights should serve as a beacon to mental health social work education. However, mental health service-users’ perspectives about social workers’ qualities remain under-researched and should be further explored (Wilberforce et al., 2020).

Students

Despite being the ‘direct recipients’ of social work education, students’ perspectives regarding BSW graduates’ mental health knowledge have been largely overlooked. McCusker and Jackson (2016) examined BSW students’ preparedness for working with mental distress in their final year placements (not just in mental health services) in Scotland. Students reported that addressing service-users mental health needs was common across all types of practice placements. Nevertheless, most students felt unprepared, with some even feeling fearful and anxious, to work with people with mental distress. Students referred to insufficient teaching of mental health at the university level. They advocated broad coverage of mental health knowledge, including sociological, recovery-related, and bio-medical knowledge. Students also sought improved mental health-related skills, especially regarding working with self-harm and suicidal behaviors. Despite these knowledge and skill gaps, students gave ample examples of providing transformative mental health social work practice. Students’ practice was guided by relationship-based and holistic approaches combined with persistence when facing barriers.

The above review implies that BSW mental health social work education should be guided by a relationship-based holistic approach oriented toward recovery and social-justice. Nevertheless, to date, no study has integrated stakeholder perspectives regarding BSW graduates’ mental health knowledge in order to inform curriculum design. Furthermore, the perceptions of service-users and especially of students, remain under-researched. Set in the Israeli context, the current study aims to gain knowledge and insights by integrating service-users’, students’, and academic-educators’ perspectives. It does so by asking these three stakeholder groups: ‘What kinds of mental health knowledge do BSW students need to have upon completion of their studies?’. The integrated findings are expected to support curriculum development.

Methods

Qualitative methodology was selected as it enables an in-depth understanding of participants’ perspectives regarding BSW graduates’ mental health knowledge (Denzin & Lincoln, 2008). Within this framework, inductive thematic analysis was chosen as it facilitates identifying, analyzing, and interpreting themes rooted in participants’ experiences and meaning-making processes (Braun & Clarke, 2006).

The Israeli context

Thirteen social work departments in Israel offer BSW degrees across different academic institutions. Six of these are placed in universities, and seven in academic colleges. Generally, universities are research-oriented, and colleges are teaching-oriented, but this distinction is less significant at the BSW level. To date, the only mandatory mental health course in BSW social work curriculum is ‘Psychopathology’ (Israeli Council of Social Work, 2016). As its name implies, and despite some variation between different departments and lecturers, the course has a bio-medical focus. Typically, the course reviews the symptoms of different mental disorders based on the DSM or ICD diagnostic manuals (The ICD is the formal manual used in Israel. However, the DSM is widely used in mental health education and practice). Most social work departments offer mental health-related electives covering various topics such as: ‘Treating anxiety with cognitive behavioral treatment’, ‘Stress and trauma: Introduction to trauma-informed social work’, and ‘Stigma, social exclusion, and social inclusion’. In addition, six social work departments (five colleges and one university) offer an elective mental health ‘concentration-track’ in which students partake field placements in mental health services, accompanied by a mental health-focused practicum course and sometimes additional mental health courses. Service-user involvement is not mandatory in Israeli social work education, with barriers resembling those identified by Basset et al. (2006) nearly 20 years ago in the UK context. Despite these challenges, service-user involvement is growing, although it is mostly confined to single-session guest-lectures (Kraus & Moran, 2019).

Participants

Thirty-nine people from three stakeholder groups (students were divided into BSW and MSW students) participated in the study—ten were Mental Health Experts By Experience (MHEBE), ten were social work academic-educators who taught mental health courses, ten were BSW students in their second or third year (out of a three-year degree), and nine were first or second MSW students (out of a two-year degree). All participants were Jews. One was of Ethiopian descent (A Jewish racial minority group).

We aimed to encompass the perspectives of stakeholders from different educational settings. Thus, educators and students were recruited from five social work departments across Israel—three universities (located in major cities) and two academic colleges (situated in peripheral regions). One university and one academic college had mental health concentration-tracks as part of their BSW degree, though most students participating in this study did not attend such a track. MHEBEs were not institutionally affiliated and were involved in student education across many higher education institutions. The following presents a short description of each participant group.

MHEBEs

MHEBEs are people with lived experience of mental health who are involved in social work education. Seven were women, and three were men. Their average age was 43.5 (range 33–55). All MHEBEs had long experiences of receiving services from social workers and other mental health professionals, enabling them to represent the ‘service-user perspective’. On average MHEBEs had 5.6 years of involvement in social work education (range 3–10 years), most commonly by providing guest-lectures. This experience gave them some understanding of social work education. Eight MHEBEs also had current or past work experience as Peer Support Workers (PSW), with an average of 8.5 years of experience (range 1–16 years). This allowed them to draw on their experiences as service-providers and colleagues of social workers. Five MHEBEs had no academic education, two were bachelor-level students, and three obtained academic degrees (none studied social work).

Academic-educators

Nine women and one man participated in the study. Their average age was 48.4. Educators varied greatly in their teaching experience (average − 13.3 years). Five were veterans with over 12 years of teaching behind them (maximum − 30), bringing a long-term perspective of social work teaching. Five others were making their first steps as academic staff (range − 3–6 years), bringing a fresh perspective on social work education. All educators except one were social workers by training. Nine educators had a Ph.D., and one was a Ph.D. student. Educators taught various mental health courses (some more than one course and in more than one institution), thus contributing versatile perspectives about mental health education. Three taught the ‘psychopathology’ course. Three taught in BSW mental health concentration-tracks and another two in MSW concentration-tracks. All educators had experience as mental health practitioners allowing them to bring the ‘practitioner voice’ alongside their academic perspective.

BSW students

Five women and five men participated in the study. BSW students’ average age was 27.5 (range − 25–31). Six were in their second year, and four in the third year of their degree. BSW students contributed their experiences and insights from their ongoing BSW mental health social work education. One student was undertaking a mental health practice-placement. Four others had past work experience in mental health services (not in a professional social work role), enabling them to refer to the interactions between mental health education and practice. Despite none of the questions directly addressing students’ mental health condition, four voluntarily identified as having significant lived-experiences of mental health.

MSW students

Seven women and two men participated in the study. Their average age was 30.7 (range − 25–39). MSW students’ major contribution is their ability to provide retrospective insights regarding their BSW education after engaging in social work practice. Four worked in community mental health services, and five in non-mental health-specific roles, allowing exploration of the interaction between mental health education and practice from both within and outside of mental health services. Five had three years or more of experience as social workers (maximum − 11 years), while four had one year or less of experience. Thus, as a group, they represented both experienced and novice social workers. Three MSW students identified as having significant lived-experience of mental health conditions.

Ethics

The research process itself was underpinned by a principlist ethical framework emphasizing participants’ consent, autonomy, and safety (Wiles, 2012). Data interpretation and the resulting educational-insights were inspired by Banks’s (2011) ‘situated ethics of social justice’. Ethics approval was obtained from a university social work department review-board. Participants received the informed consent form before the interview and gave their permission by signing it physically or by e-mail confirmation. It was made clear that participation is non-obligatory, anonymous and that participants may withdraw at any stage. Interviews were transcribed by the first-author and by a professional transcription company. Transcribers were instructed to cease transcription if they identified participants. Only the first-author (who conducted the interviews and data analysis) had information about participants’ identity.

Data collection

MHEBEs and lecturers were recruited based on personal acquaintance, screening mental health social work syllabuses in the relevant departments, and snowball sampling (Biernacki & Waldorf, 1981). Students were recruited by posting messages on departmental social media, assistance from academic and field colleagues who informed students about the research (students initiated first contact with the researchers), and snowball sampling (Biernacki & Waldorf, 1981).

The study is part of a broader Ph.D. study addressing mental health knowledge and service-user involvement in social work academic education. Data was collected between August 2020 and May 2022 using a semi-structured interview (Galletta & Cross, 2013). The first-author conducted all interviews. Due to COVID-19 restrictions 32 interviews were conducted using a video call (using Zoom software), and seven were conducted face-to-face. No differences were detected between interview methods.

The findings presented in this study introduce data collected in the first part of the interview. Participants were asked to address the question: ‘What kinds of mental health knowledge do BSW students need to have upon completion of their studies?’. In line with the inductive approach, interviews were open and conversational, encouraging participants to put forth their own discussion topics and priorities regarding the research question. Once atopic\subject was explored, the interviewer re-introduced the research question inviting participants to expand on other issues. This phase took between ten to thirty minutes (with MHEBEs and educators on the longer range). It was concluded once participants stated they had no further additions or when the interviewer felt that participants’ answers did not add new information.

Data analysis

Inductive thematic analysis was applied using Braun and Clarke’s (2006) model. Aiming to first identify patterns within each group, data-extracts relevant to the research question were extracted into four separate documents—according to each participant group. However, coding was also an integrative process as insights from one group (such as code names and boundaries between codes) were incorporated into the coding process of other groups. This included returning to previously coded data and updating code names and data-extracts’ code-allocations according to new insights. Theme identification started within participant group by searching for connections and relationships between codes and collating data-extracts for each potential theme. While this process was implemented separately for each group, it involved constant comparison between groups. This process allowed to gain in-depth understanding of each group’s discourse while connecting meaning-threads between groups. As this ‘separate yet integrative’ process advanced, the within-group thematic structures gradually became more and more similar across groups, finally enabling the construction of a between-group thematic structure. According to this structure, data-extracts from all groups were integrated. Integrated themes were reviewed to check for theme coherence. Additionally, raw-data was re-read to confirm themes are aligned with participants’’ intentions and interview context. Finally, the integrated themes were analyzed, ‘identifying the “story” that each theme tells’ (Braun & Clarke, 2006, p. 92). The first-author conducted data analysis with guidance and consultation with the second-author.

Results

The above-described data analysis resulted in an integration of stakeholder perspectives while accounting for points of convergence and divergence between and within groups. In some themes, participants’ views were generally aligned, thus allowing a uniform presentation of findings using the word ‘participants’. Other themes were more complex, with different voices heard between and within groups. In these cases, the narrative explicitly mentions ‘who said what?’.

Analysis of participants’ references regarding the question—What kinds of mental health knowledge do BSW students need to have upon completing their studies?—revealed three major themes: 1. Person-centered approach. 2. Negotiating the role of bio-medical knowledge. 3. Mental health knowledge broadened.

Person-centered approach

For most participants across stakeholder groups, adopting a person-centered approach was perceived as the central ‘thing BSW graduates should know’ about mental health. Embracing a holistic perspective of service-users as whole and complex human-beings and avoiding reducing their identity to a psychiatric diagnosis was described as the cornerstone of person-centered approach:

People are complex … they may have schizophrenia, bipolar disorder or PTSD, but they are also many other things. I think that social work tries to shed a light on these other things. (BSW 5)

Beyond acknowledging service-users’ humanity, participants emphasized that it is essential that social workers position themselves first and foremost as human-beings and only then as social workers. One MHEBE phrased this idea using the Hebrew term ‘Ish-Tipul’ (a human-being who provides therapy), which is commonly used to describe mental health professionals:

You are not just a social worker, you are an ‘Ish-Tipul’ – a human who provides therapy to another human. When you put things that way, then there is less distance [between the social worker and the service-user, E.K.]. (MHEBE 6)

Adopting a person-centered approach was described as social workers staying humble, curious, and non-judgmental toward service-users. It also includes putting service-users’ needs and goals as top-priority, and acknowledging them as experts of their own lives:

The BSW graduate I see in my vision … [is someone who says, E.K.] ‘I will first try to understand what the service-user wants and not what Winnicott said. It might be that Winnicott was right, but the service-users are the ones who know best what they need’. (MHEBE 7)

A few participants (mostly educators and MHEBEs) emphasized the construction and maintenance of a meaningful and trustful working alliance with service-users as an invaluable component of adopting a person-centered approach:

I always tell students, ‘It doesn’t matter with which service-user group you are working and which theory you use, the relationship is the foundation. In order to establish a relationship, you must be with the person where they stand’. (Educator 6)

Within this relationship-based approach, participants highlighted the importance of BSW graduates’ ability to self-reflect on what they bring into the relationship and how it can impact themselves and the relationship itself:

They need to constantly ask themselves, ‘what is happening to me?’, ‘what am I feeling right now?’. They are the instrument through which work is being done, so they have to be very attentive to ‘what happens to me in this relationship?’ (Educator 2)

Negotiating the role of bio-medical knowledge

Bio-medical knowledge was a contested subject. On the one hand, it was perceived as a valuable resource to inform BSW graduates’ understanding of mental health. On the other hand, its medical-focus was seen as standing in tension with the principles of the person-centered approach.

Most participants believed that bio-medical knowledge is an important component of BSW graduates’ knowledge base as long as it does not overshadow the person-centered holistic perception of each service-user:

It’s important to know that people are not diagnoses and that no person with a diagnosis is similar to another person with the same diagnosis. Each person has their own unique coping resources. Nevertheless, I still believe it is important to be acquainted with typical conditions social workers may encounter. (BSW 9)

Participants from all stakeholder groups warned against a full endorsement of bio-medical discourse as its focus on pathologies may compromise BSW graduates’ ability to approach mental health from a person-centered perspective. This warning was especially voiced in the context of the psychopathology course, which students described as medically-focused:

What I mostly remember from the psychopathology course is the feeling of despair … You learn that the statistics for people whose symptoms are no longer present according to the DSM are very low … It paints a very grim picture … There was no reference to recovery [the premise that people with mental health conditions can live a meaningful life, E.K.], which in my experience is even perceived as a dirty word … It saddens me because students proceed to practice and don’t believe that service-users can feel better. (BSW 2)

Educators who taught psychopathology courses shared how they tried to address this issue using various methods, including: incorporating person-centered language in their teaching, inviting MHEBEs as guest-lecturers, and teaching classes about the political aspects of the DSM. Yet, one MHEBE and one student doubted if such efforts are enough to impact students’ attitudes within the medicalized atmosphere of the psychopathology course:

Once the symptoms take so much space [making a wide gesture with her arms, E.K.] and the message that you can live with it [mental health conditions, E.K.] is just a small line … it actually produces stigma among professionals. (MHEBE 10)

While advocating for a person-centered, strength-based approach, a minority of participants cautioned against what they described as social work’s tendency to concentrate on strengths and avoid pathologies:

Many times, social work is afraid to address pathologies and not strengths. I’m not saying that social work is opposed to addressing pathologies, it just kind of leaves it to other professions. (BSW 5)

In this context, one MHEBE (notably the same one who criticized the psychopathology course) who works as a PSW in a mental health hospital explained how overlooking bio-medical knowledge can actually impede BSW graduates’ ability to form a holistic understanding of service-users’ conditions and needs:

I see social workers who design a plan aimed at helping a service-user to wake up in the mornings, without accounting for psychiatric medication side-effects like sleepiness. On the other hand, I see others who say, ‘maybe I should consult the psychiatrist and try to understand if the service-users’ difficulty to wake up is motivational or is it a medication side-effect? Because then [if it’s a medication side-effect, E.K.] we need to stop and have a think about how to help the service-user’. (MHEBE 10)

In addition, several participants (especially students) pointed to the need to equip social work graduates with skills designated to working with specific psychiatric conditions/symptoms and crisis intervention. While participants acknowledged that it is impossible to teach a multitude of specific intervention skills, they still emphasized the absence of psychiatric intervention skills in social work training. One student addressed the ‘skill lab’ course, which teaches basic social work interventions skills:

Why not teach some skills about how to support someone who has depression, bipolar disorder, schizophrenia … just basic, or even conceptual, skills that can give us some direction. Though many subjects require such attention, so I don’t know if it’s practical. (BSW 7)

Despite the psychopathology course’s focus on bio-medical knowledge, the absence of mental health skill training left students feeling anxious and unprepared for mental health practice, as can be seen in one psychopathology course teacher’s summary of the feedback she received from students at the end of the course:

The students finished the course a little bit anxious … [They asked, E.K.] ‘What do I do with schizophrenia?; What do I do with depression?; How do I cure these things?’ (Educator 5)

Mental health knowledge broadened

Besides person-centered approach and bio-medical knowledge, participants addressed several topics which they believed to be important as they broaden the scope of BSW graduates’ mental health knowledge. This theme presents the major topics discussed by participants.

First, several participants claimed that being able to understand (as much as possible) the subjective experiences of mental health should be a central component of BSW graduates’ knowledge:

They need to understand depression and other conditions, not just on the diagnostical level, but through peoples’ experiences. It’s important to hear as many experiences as possible - about experiencing crises, about how it feels, about what helps. (MHEBE 4)

Participants highlighted MHEBEs’ involvement in social work education as the primary pedagogy through which such an understanding can be achieved:

The most significant knowledge is meeting people and hearing about their lived-experiences … It’s an essential knowledge students should possess before approaching practice. (MSW 2)

Second, some participants asserted that BSW graduates’ knowledge should be relevant and connected to changes in the mental health field. Students claimed that involving mental health practitioners and MHEBEs in their education can strengthen its connection to recent changes in the field:

I would like to learn from people who are not academic researchers… that working in mental health is their daily job. I think that a connection to the field is much more important than knowledge from research. (MSW 2)

MHEBEs and educators (but notably only a small minority of students) asserted that students should be acquainted with the concept of recovery and gain recognition that recovery is real and not a myth:

Students need to … be acquainted with the concept of recovery and what helps recovery to manifest - like meaning and hope. (MHEBE 5)

Educators stressed that incorporating recovery into the curriculum serves as a major objective in their teaching:

Formulating a deep understanding of the various ways to understand and advance recovery serves as the central principle of my teaching. (Educator 3)

Beyond recovery, MHEBEs emphasized introducing new approaches/practices/services that entered the Israeli mental health field in the last couple of decades, such as open-dialogue and the Soteria model. In the same vein, but with a slightly different focus, educators pointed to new paradigms/approaches, such as trauma-informed approach, cultural sensitivity, and emotion-focused therapy, through which students can understand mental health.

Third, knowledge about the rights and services available to mental health service-users was considered by a few MSW students and MHEBEs as crucial to BSW graduates’ capability to offer assistance to service-users:

Every BSW graduate who works in social services will meet many families who are coping with mental health conditions … [They need, E.K.] to be knowledgeable about the different mental health services and basic rights realization. (MSW 8)

Despite its significance to practice, participants pointed to an absence of knowledge about rights and services in Israeli social work education. One MSW student who works as a case-manager in a community mental health rehabilitation service shared her early work experiences:

I was totally clueless about the mental health field, about what options service-users have, what I can offer them. These things do not receive attention [in mental health education, E.K.]. (MSW 3)

Fourth, A small yet vocal number of participants (mostly educators and BSW students) stressed the importance of contextualizing mental health education through the lenses of historical, political, and critical knowledge. One student described how understanding the broader political context of mental health can help students provide better services on both the social and the interpersonal levels:

Advocating for service-users or helping them advocate for themselves is part of social work practice. Once you understand the political situation and where service-users are excluded, then you can work towards change. In addition … when I understand that someone is excluded and the experiences accompanying exclusion, I can better understand their feelings. (BSW 4)

Participants indicated that students might profit from the critical examination of the historical development and current state of mental health systems, the socio-political contexts (such as poverty) influencing service-users’ lives, and the discourses (most notably bio-medicalism and neo-liberalism) which affect the construction of mental health knowledge:

The emphasis on functioning as part of recovery is just nonsense. Functioning is important, but it is also a political and economic issue. It is a central neo-liberal value—if you don’t function, then you’re not worth anything. This is manifested [in recovery discourse, E.K.]. (MSW 6)

Discussion

In order to inform BSW mental health curriculum, this study set out to integrate service-users’ (who are MHEBE), students’, and academic-educators’ perspectives regarding the kinds of mental health knowledge BSW students need to have upon completion of their studies. Thus, the following discussion will present four educational-insights derived from the findings.

Articulate recovery as the mental health framework for person-centered approach

Adopting a person-centered approach was perceived by all participant groups as the foundation for mental health practice. Participants described person-centered approach as a holistic, humane, and non-judgmental approach to practice, which aims to support the attainment of service-users’ needs and goals. This description of person-centered approach is compatible with social work’s core values (International Federation of Social Workers, 2018).

Some participants emphasized the importance of constructing and maintaining a meaningful working alliance as a significant facet of person-centered practice. This reflects the growing recognition of relationship-based social work. Relationship-based social work views the relationship between the service-user and the social worker as the medium through which social workers and service-users can jointly attend to service-users’ needs and promote their goals on the individual, family, community, and societal levels (Krumer-Nevo, 2016; Trevithick, 2003). Indeed, forming strong working alliances based on person-centered principles has been described by service-users as desired qualities of mental health social workers (Wilberforce et al., 2020).

Given their scope and relevance to the entire social work field, person-centered approach and relationship-based social work should be incorporated across the social work curriculum (IASSW & IFSW, 2020). Nevertheless, the mental health curriculum should draw connections between these overarching concepts and mental health theory and practice. When considering this proposition, the recovery approach seems to be an appropriate fit.

Recovery is a well-established mental health paradigm (WHO, 2022). However, it is criticized as being co-opted by professional and neo-liberal forces, thus losing its radical-political edge (Recovery In The Bin, 2017). Recovery is based on the premise that people with mental health conditions can live meaningful and contributive lives in the communities they choose (Gyamfi et al., 2022). Interestingly, two recent (but separate) systematic/scoping reviews found that ‘person-centered’ is the most often cited component of recovery, addressed by over 80% of the articles reviewed (Ellison et al., 2018; Gyamfi et al., 2022). Furthermore, adopting a person-centered approach and harnessing meaningful working-alliances were identified as core components of recovery-oriented practice (Russinova et al., 2011).

It is thus unsurprising that there are consistent calls to align social work mental health education and practice with recovery principles (Carpenter, 2002; Oh & Solomon, 2013; Whitaker et al., 2022). Such a call was also found in the current study as MHEBEs and educators (especially of elective courses and concentration-tracks) highlighted the importance of recovery as a paradigm that should guide mental health social work education. They also stressed that it is imperative for students to understand that recovery is possible. Despite these calls and students’ proclivity toward person-centered approach, students scarcely mentioned the concept of recovery. This implies that students were not able to draw on recovery theory in order to ground their person-centered approach in the mental health context. This points to the need for a mental health social work curriculum that articulates the concept of recovery, its reality, and its connection to person-centered approach, social work values, and relationship-based social work practice (Carpenter, 2002; Oh & Solomon, 2013). Nevertheless, articulating recovery should also include critical deconstruction of the political forces shaping the recovery discourse and the dangers of individualization, de-politicization, and exclusion that an overly person-centered recovery approach encompasses (Whitaker et al., 2021, RITB, 2017; Sapouna, 2016).

Teach bio-medical knowledge from a person-centered holistic perspective

This study shows that a majority of participants across stakeholder groups believed that the bio-medical paradigm should not govern social work education and practice. They stressed that focusing on biological pathologies may induce a reductionist perception of ‘persons as diagnoses’, which stands in conflict with the desired person-centered approach. These findings resonate with the claim that a biological-reductionist perspective is opposed to social work’s values and holistic approach (Morley & Stenhouse, 2021). In accordance with this position, participants were critical toward the psychopathology course. Some claimed that despite teachers’ sincere efforts, the course is structurally dominated by bio-medical knowledge, which entices stigma and pessimistic attitudes toward people with mental health conditions. This claim is reinforced by previous criticism of the psychopathology course as adhering to bio-medical conventions (Lacasse & Gomory, 2003) and by Sherwood’s (2019) findings that psychiatry-focused courses did not challenge stigmatic attitudes among pharmacy, nursing, and social work students.

Despite this criticism, Participants believed bio-medical knowledge should be incorporated into BSW graduates’ person-centered biopsychosocial understandings of mental health. This resonates with earlier findings in which social work practitioners (Hitchens & Becker, 2014) and educators (Lyter & Lyter, 2016) acknowledged the value of bio-medical knowledge in constructing a holistic understanding of service-users. It recognizes the pragmatic need to prepare students for a field in which the bio-medical approach dominates discourse, practice, and legal-economical procedures (Frazer et al., 2009; Lyter & Lyter, 2016). Yet, it avoids bio-medical knowledge becoming the sole ‘lens’ through which BSW graduates understand mental health (Satterly, 2007).

Educators have developed pedagogies that enable students to engage with bio-medical knowledge as part of a wider biopsychosocial context (Dewees & Lax, 2008; Satterly, 2007). Such pedagogies can inform curriculum design. In addition, incorporating knowledge about and pedagogies from (relatively) new approaches, such as open-dialogue (Seikkula & Olson, 2003), which shift the spotlight from the ‘sick person’ to a wider context, may contribute to students’ holistic understanding of mental health. Yet, the current study shows that these pedagogies should not serve as auxiliaries in a bio-medical-focused curriculum. Rather, they should be grounded in a curriculum that is rooted in social work’s value-base and theory (Dewees & Lax, 2008; Whitaker et al., 2022) and presents mental health as determined by a ‘diverse set of individual, family, community and structural factors’ (WHO, 2022, p. xiv). In the Israeli context, this calls for curricular reform in social work mental health education.

Ground person-centeredness in a socio-political context

In her discussion of mental health social work in England, Karban (2017) distinguishes between ‘downstream’ social work facing individual-level determinants of mental health and ‘upstream’ social work facing the socio-economic, political, and environmental determinants of mental health. In this study, adopting a person-centered/recovery-oriented approach (‘downstream social work’) was addressed by the vast majority of participants. Nevertheless, only a small minority emphasized that BSW graduates should also gain deep understanding of the historical, social, and political contexts which impact service-users lives as well as mental health social work knowledge and practice (‘upstream social work’).

Karban (2017) advances mental health social work that ‘faces both ways’, in which social workers are committed to promoting mental health on both micro-individual and macro-societal levels. She proceeds to claim that:

This approach can also be seen as offering an inherent critique of the concept of ‘recovery’ as it is widely understood in policy and practice, grounded in a discourse of individual choice and responsibility and positioned within an individualised, neo-liberal agenda. (Karban, 2017, p. 866)

This sheds new light on this study participants’ focus on person-centered/recovery approach. While such an approach is aligned with some social work values and holds the potential to negate bio-medical reductionism, without firm grounding in socio-political context and commitment to social-justice, it is prone to be ensnared in neo-liberalism’s narrative of individualistic self-determination and client-responsibilization (Karban, 2017; Whitaker et al., 2021).

In their analysis of what they term ‘the neo-liberal colonization of social work education’ Morley et al. (2017, p. 34) claim that:

It is increasingly important that social work curricula explicitly resist complicity with individualistic explanations of social problems that ignore structural causes of inequalities. This critical consideration can extend across all aspects of curricula.

In light of the above findings and analysis, BSW mental health social work education should embrace a person-centered approach while grounding it in a curriculum that underlines the socio-political contexts of mental health and affirms social work’s commitment to social-justice (Sapouna, 2016; Whitaker et al., 2022). Providing students with knowledge and opportunities for critical reflection about the social determinants of mental health, its socio-historical context, and the effects of neo-liberalism on social work mental health practice can all serve as valuable components of the curriculum (Whitaker et al., 2021). Adopting insights and pedagogies from established critical theories, such as poverty-aware-paradigm (Krumer-Nevo, 2016), that strive to challenge neo-liberal domination can also prove beneficial additions. Moreover, MHEBE involvement in mental health education should not be restricted to their personal illness and recovery stories but also draw on their insights and criticisms of the recovery concept itself and the structural-political-policy level (Voronka & Grant, 2022).

Besides engaging students with critical knowledge and reflection, the findings of this study point to the need to equip them with concrete knowledge about rights and services. With such knowledge in hand, social workers can inform service-users’ about and support their attainment of rights and services, thus promoting person-led advocacy and social-justice (Maylea et al., 2020).

Involve service-users and practitioners in academic education

Several participants claimed that service-user involvement in social work education could contribute to BSW graduates’ mental health knowledge. This is corroborated by the growing evidence that service-user involvement broadens students’ understanding of the subjective experiences of living with mental health conditions, reduces stigma, and encourages reflection about the power relations between social workers and service-users (Adamson et al., 2022; Kraus & Moran, 2023; Stanley & Webber, 2022). In addition, some participants (mostly students) voiced the call for the involvement of social work (and other professions) practitioners in students’ academic education. Interestingly, despite practitioners’ significant role in social work field-education, practitioner involvement in social work mental health academic education has received limited research attention. The current study points to the need to deepen our understanding of the potential contributions and challenges of practitioners’ involvement in academic education (Cavener et al., 2020; Olivant & Greenwood, 2021).

By ‘grounding the curriculum in the real world’ (Ii et al., 2022, p. 5) service-users and practitioners can reduce the theory-practice gap and augment the mental health curriculum (Cavener et al., 2020). Service-user and practitioner involvement can also assist in reducing students’ anxiety toward mental health practice. Service-users can share experiential-wisdom regarding what helps them and what they need and expect from social workers (Kraus & Moran, 2023; Schön, 2016). Practitioners can share with students practice-wisdom about helping people with mental health conditions. While these sharings are not concrete psychiatric intervention skills, they might serve as practice guidelines that will help students approach mental health practice more confidently (Kraus & Moran, 2023). In addition, Role plays and the general ongoing interaction between students and service-users within the safe and supervised classroom environment can contribute to students’ readiness for mental health practice (Ii et al., 2022). Furthermore, service-user involvement in students’ academic education can serve as a model of person-centered practice, as it positions service-users at the center and shifts (to a certain extent) the spotlight from professional expertise to experiential expertise (Ii et al., 2022). However, Voronka and Grant (2022) claim that service-users with ‘acceptable stories’ (i.e. narratives that align with professionals’ perspectives about mental health) are often preferred over more radical and critical service-users voices. Yet, it is these critical voices that often encourage students’ reflection on social work mental health practice (Sapouna, 2016). Thus, service-user and practitioner involvement should include people with diverse experiences and opinions, exposing students to multiple perspectives on mental health.

Limitations

This study has several limitations. While the study offers an integration of stakeholders’ perspectives, it does not encompass all the stakeholders involved in mental health social work education and practice. Further research is required in order to incorporate the perspectives of field-educators, managers, supervisors, carers, and family members, as well as of colleagues from other professions who work alongside social workers. Another limitation stems from the homogeneity of the participants. All participants were Jews, and only one was from a (Jewish) racial minority. This may explain the general absence of cultural diversity and other topics, such as racial, ethno-national, and political discrimination in participants’ discourse. Research that engages with heterogenous participant samples in different national/jurisdictional contexts is required. Furthermore, most MHEBEs participating in this research worked as PSWs. Thus, they were themselves part of the mental health system. This runs the risk of excluding service-users who are more critical of the mental health system. Future research should amend this by including a more diverse group of service-users. Finally, the data was collected as part of a wider project pertaining to service-user involvement in social work education. This may have influenced participants’ references regarding social work mental health knowledge. This study showed that stakeholders’ perspectives on social work mental health education deserve their own focused research. Thus, future research can offer more in-depth exploration of the subject.

Conclusion

BSW graduates who enter professional practice are prone to provide services to people with mental health conditions. This study shows that social work mental health academic education can benefit BSW students if it incorporates a person-centered, recovery-oriented, relationship-based approach to mental health practice. Furthermore, it is important to embed such an approach in critical understanding of and engagement with the socio-political contexts which affect service-users’ lives. To support this, the curriculum will be augmented by addressing concrete knowledge about rights and services. In addition, service-users and practitioners should be involved in the design and implementation of the curriculum, contributing from their experiential and practice knowledge and keeping the curriculum close to the realities of mental health practice. Finally, mental health education should draw on general components of the social work curriculum, such as person-centeredness, relationship-based social work, and commitment to social-justice, and establish their mental health-specific connections, such as recovery and critical mental health knowledge. It is acknowledged that designing and implementing such a curriculum is challenging, especially given the dwindling resources and amounting pressures educators face (Morley et al., 2017). Yet, our duty as educators remains to strive as much as possible toward educating BSW graduates who provide effective and transformative mental health social work.

Acknowledgments

The authors thank the study participants for contributing their knowledge and insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Eran Kraus

Eran Kraus is a PhD student in the department of Social Work, Ben-Gurion University of the Negev, Israel.

Galia Sharon Moran

Galia Sharon Moran is an associate professor, head of mental health track in the department of Social Work, Ben-Gurion University of the Negev, Israel.