Mental Health Social Work and the Troubles in Northern Ireland: A Study of Practitioner Experiences

• Summary: During the last decade increasing attention has been paid to the impact of the Troubles1 on social work in Northern Ireland. In this paper, the authors describe the first survey used to test some of the assumptions which exist in the literature. An 87-item questionnaire was applied to a range of social work staff currently working in, or associated with, mental health settings. One hundred and one questionnaires were returned: it is estimated that this represented over 70 per cent of mental health social workers in Northern Ireland. • Findings: The design of the questionnaire elicited both qualitative and quantitative data. The findings reveal a workforce with complex religious and national identities and many of the respondents have experienced relatively high levels of Troubles-related incidents whilst carrying out their duties in a variety of organizational and geographical settings. High proportions of respondents received minimal agency support and training to equip them to deal with Troubles-related problems faced by them during this period. • Applications: The authors conclude that the profession and employing agencies should pay greater attention to past and present effects of the Troubles on social work practice and develop appropriate strategies for supporting, training and resourcing staff in this neglected area.

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between service user and professional social work discourses and provides a critical commentary on their respective contributions to the recent review of mental health policy and legislation in Northern Ireland. The analysis indicates that dominant trends in mental health care, as mediated through service structures and institutional identities, have tended to prioritize the more coercive aspects of the social work role and reinforce existing power inequalities with service users. It is argued that such developments underline the need for a ‘refocusing’ debate in mental health social work to consider how a more appropriate balance can be achieved between its participatory/empowering and regulatory/coercive functions. Whilst highlighting both congruence and dissonance between respective discourses, the paper concludes that opportunities exist within the current change process for service users and social workers to build closer alliances in working together to reconstruct practice, safeguard human rights and develop innovative alternatives to a traditional bio-medical model of treatment.

Maternal mental health and non-organic failure to thrive.

This study reports on the first phase of a large-scale, longitudinal, multidisciplinary community study examining the growth, learning and development of young children with a particular focus on failure to thrive without organic cause. However, the group identified in this study may be better described as weight faltering. This paper examines the psychological data collected using the Parenting Stress Index, Rosenberg Self-Esteem and the General Health Questionnaire in relation to child growth. There were no significant differences between the mothers of the weight faltering and control children in terms of parenting stress, maternal depression, maternal perceptions of their parenting competence or maternal self-esteem. Maternal sensitivity to comments about child size, regardless of direction, had a negative impact on mood.

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland.

In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.