Mental Health Recovery Paradigm: Implications for Social Work

Since the early years of the profession, social work has had a commitment to work with people who have psychiatric disabilities (Peterson et al., 1998). In movements that shaped both the profession and psychiatric services themselves, social workers in the early 20th century were involved in mental health care through direct practice, state-level advocacy, and policy development (Vourlekis, Edinburg, & Knee, 1998). Social work and mental health care have evolved considerably since that time, but the profession has consistently provided an invaluable contribution to this multidisciplinary field and the field, in turn, has helped define social work practice and its domain. Today, many social workers continue to find employment in settings that serve people with psychiatric disabilities. A recent survey of NASW members revealed that psychiatric hospitals were the primary work setting for 5.3 percent of the respondents and that 16.4 percent of respondents worked primarily in an outpatient mental health setting (Peterson et al., 1998). An additional 13.5 percent of respondents reported that an outpatient mental health clinic was their secondary employment setting (Peterson et al., 1998). Furthermore, given that psychiatric disability affects about 4.8 million adults in the United States each year (Kessler et al., 1996), it is reasonable to assume that even those social workers who do not work in mental health settings will at some point serve people who have psychiatric disabilities. Over the years, many varieties of services and treatment models for people with psychiatric disabilities have been developed. For instance, recommended services for people diagnosed with schizophrenia now include medication management, vocational rehabilitation, outreach/case management, and individual, group, or family therapy that is supportive and educational or targets behavioral and cognitive skills (Lehman, Steinwachs, & Co-Investigators, 1998a). A recent client survey indicates that of these services, those related to medication management are offered the most often (Lehman, Steinwachs, & Co-Investigators, 1998b). Rates of receipt of other recommended services ranged between roughly 10 percent and 45 percent among outpatient respondents (Lehman et al., 1998b). Figures such as these do little to answer the concern that today's mental health system is founded in the medical model. Although medicine has clearly made vital contributions to the array of treatment options for people with psychiatric disabilities, near-exclusive reliance on this approach to services has been detrimental to the functioning of the system. Critics have argued that the system is preoccupied with the assumption that psychiatric disabilities are organic, biological diseases (Chamberlin, 1998), resulting in a vision of the client as a diagnosis rather than an individual (Deegan, 1996). Others have asserted this assumption is too frequently accepted as fact when research has yet to support it as anything other than a group of hypotheses and theories (Arben, 1996). Furthermore, the system has been said to endorse a concept of psychiatric disabilities as typically chronic and increasingly debilitating conditions, despite a long history of longitudinal studies that clearly suggest otherwise (Kruger, 2000). Ultimately, treatment too frequently focuses on symptoms and deficits, failing to recognize or engage the whole person (Rapp, 1998), and as a result dehumanizes the client (Deegan, 1996). Such criticisms are indicative of a medical model of mental health and suggest an ideology and a services system that in many ways conflict with social work values. Social workers have been prominent among those who challenge the medical model; perhaps social work's most significant contribution to this movement has been the use of the strengths perspective in the development of a model of case management for people with psychiatric disabilities (see Rapp, 1998). …