Beyond Stigma and Discrimination: Challenges for Social Work Practice in Psychiatric Rehabilitation and Recovery

ABSTRACT

The recovery process and social work education share theoretical and practice roots that facilitate a goodness-of-fit between the profession and the empowerment orientation of recovery. This article examines the linkages between the recovery process and social work education, including areas where curricular renewal will assure that master's in social work (MSW) students and graduates embrace the recovery-oriented values that facilitate consumer-driven services. Curricular innovation is also proposed that addresses the need for MSW programs to develop supported education programs that will enable more consumers to pursue and complete graduate social work education.

KEYWORDS:

• Discrimination
• social work training
• stigma
• supported education
• supported employment

Notes

Note. From Mental Health Services Oversight and Accountability Commission (2007, p. 43).

In 2005, the California Social Work Education Center (CalSWEC) received an award from the California Department of Mental Health to implement a statewide stipend program. This award was supported by the California Mental Health Planning Council as an early award, thus accelerating the rollout of MHSA education awards by 1 year. This early approval was granted in recognition of CalSWEC's expertise in the implementation of training grants the advantage that early implementation experiences of CalSWEC could provide in identifying issues that might affect the initiation of MHSA training programs for other behavioral health professions.

The conference utilized a panel of 110 experts, including “mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation organization representatives, state and local public officials, and others” (SAMHSA, 2004). The process facilitated the examination of topics “such as recovery across the lifespan, definitions of recovery, recovery in cultural contexts, the intersection of mental health and addictions recovery, and the application of recovery at individual, family, community, provider, organizational, and systems levels” (SAMHSA, 2004).

SAMHSA has supported the development and dissemination of five evidence-based mental health interventions, including Illness Management and Recovery, Assertive Community Treatment, Family Psychoeducation, Support Employment, and Co-occurring Disorders: Integrated Dual Diagnosis Treatment. More information on each of these is available at http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/default.asp.

According to MacDonald-Wilson et al. (2001), 81% of all working-age people in the United States (without disabilities) are employed full or part time; 32% of all working-age people with disabilities are employed; and employment for those with severe psychiatric disabilities is 19%. Megivern et al. (2003) estimated that unemployment rates for adults with severe psychiatric disabilities are between 70% and 90%. In addition, compared with employment data for persons with other disabilities, individuals with psychiatric disabilities experience the “strongest stigma ratings, the lowest employability rankings, and largest productivity-adjusted wage differentials” (Baldwin & Marcus, 2006, p. 388).

The final category of the Perry Scheme, referred to as Commitment/Constructed Knowledge, is defined as the integration of knowledge learned from others with personal experience and reflection. Within this category there are three stages or subcategories: Commitment (act of making a commitment), Challenges to Commitment (the individual experiences the implications of commitment and explores the related issues of responsibility), and Post Commitment (the individual realizes that commitment is an ongoing, unfolding, evolving activity that requires the individual to be able to make and stand by difficult decisions). Individuals who operate at the level of Post Commitment are typically thought to be experts regarding the subject under consideration (Moore, 2001).

The results of the Kansas CAP Training Program (reported by Ratzlaff et al., 2006), indicated that of the first 47 graduates, 63% were employed at 6 months and also at the 2-year follow-up study. An additional 25% of the graduates were enrolled in postsecondary education at 6 months, with 21% of this second group continuing their education at 2 years. Participants reported that they felt significant improvement in their levels of self-esteem, hope, and recovery after completing the program. In the evaluation of findings recovery was defined as having two aspects: community integration and the assumption of “normal” adult roles, and the person's self-perception of psychological states such as hope, pursuit of personal goals, self-efficacy, and self-determination (Ratzlaff et al., 2006).

Additional information

Notes on contributors

Beverly Buckles

Beverly Buckles, DSW, is Chairperson of the Department of Social Work and Social Ecology, and Dean of the School of Science and Technology, Loma Linda University, Loma Linda, CA.

Emily Brewer

Emily Brewer, MSW, is a Human Service Social Worker, Sacramento County Child Protective Services, Sacramento, CA.

Jennifer Kerecman

Jennifer Kerecman, MSW, is Court Liaison and Service Coordinator, Turning Point Coloma Center, Roseville, CA.

Laurel Mildred

Laurel Mildred, MSW, is Executive Director of the California Network of Mental Health Clients, Sacramento, CA.

Amy Ellis

Amy Ellis, LMFT, is Workforce, Education and Training Coordinator of Placer County Children's System of Care, Auburn, CA.

John Ryan

John Ryan, MSW, is former Director of the Riverside County Mental Health Department, Riverside, CA.