“Bits” of social work practice in the community mental health system — everyday psychiatric care and reform directions to advance the recovery model

Mental Health has a broad and socially woven meaning depending upon where you sit.  I work with people who have needed extended support to address and manage the disability of a mental illness. These are people who in their personal history need the most intensive levels of support from hospitals or community-based levels of mental health care.

This form and intensity of service is from a particular view and while vital to contribute to any appreciation of a whole population approach to mental health, its position on the continuum of care can skew our view of population-based mental health wellness. Especially with our legacy of institutionalization which to this day haunts my everyday practice along with the legacy of a poorly managed de-institutionalization process. At the same time, there are significant service changes in play.

This change is occurring across care disciplines as well as at academic research and professional levels. The Canadian Mental Health Association’s Framework for Support of a few decades ago led by former Centre for Addiction and Mental Health social worker John Trainor, does a very good job of depicting the complex dynamic.

(Image by Canadian Mental Health Association (CMHA) Peel-Dufferin)

See the Framework here: https://cmha.ca/documents/a-framework-for-support

Social Work’s ethics, values and knowledge base bring critical pillars to community-based care and recovery practices. The bio/psycho/social practice of care which every psychiatric service posits as its framework of care continues to be the central focus. Yet, it has countless competing interests and problems in its implementation across the institutional and community systems of care encountered by clients, families and practitioners.

In 2005, the Canadian Association of Social Workers (CASW) provided a Summary of Core Social Work Values and Principles relevant to community practice in mental health.  https://www.casw-acts.ca/sites/default/files/attachements/code_of_ethics_values_principles_0.pdf

They are the following:

Value 1: Respect for the Inherent Dignity and Worth of Persons
 diversity, oppression and privilege; informed consent, client decision making, client rights and responsibilities

Value 2: Pursuit of Social Justice:
 social determinants of health, income distribution, discrimination, marginalization, policy and social/organizational structures, antiracism

Value 3: Service to Humanity
 use of power and authority, knowledge and skills, development of a just society, assessment and intervention techniques/approaches (individual, group, social), international linkages

Value 4: Integrity in Professional Practice
 professional practice and integrity, promoting values of the profession within organizations, neutral/non-neutral use of self in professional comportment

Value 5: Confidentiality in Professional Practice
 informed consent, transparency of process

Value 6: Competence in Professional Practice
 ongoing research and knowledge development for the profession, individual continuing competency, schools of social work.

My everyday practice covers long-term involvement with clients to advance community inclusion. Ronald Labonté of the Globalization and Health Equity Research Unit (http://www.globalhealthequity.ca/) of the University of Ottawa Institute of Population Health examines the concept of client empowerment when providing care in Health Promotion and Empowerment: Practice Frameworks (1993). He makes an important point in the context of “empowerment” where both client citizenship and support for personal agency through the community development process are occurring along with the clients themselves needing both direct service and care. He notes:

“The two pillars that allow service delivery to be empowering are, first, that is offered in a supportive, non-controlling way and, second, that is not the limit of the resources offered by the agency. The combination of these two pillars has
been referred to as “developmental casework.” In contrast to more traditional forms of casework or case management, “developmental casework is developmental, with an explicit goal the development (empowerment) of the individual receiving the support, and the creation of links between these individuals.” This approach builds towards community organizing and coalition advocacy – and hence the political elements of empowerment at the structural level remain explicitly…people have the right, here and now, to support in the face of difficulties… “ (p. 61)


In social work, the well-known practice wisdom is that our moral distress and/or burnouts are more often about the politics of systems rather than the people we serve. A useful resource for my own impatience was developed in Great Britain to support practitioners in addressing social inclusion and stigma via a personal competence guide: Capabilities for Inclusive Practice (2007). (https://tinyurl.com/ycfjp6z8)

The social inclusion capability framework comprises:

ESC1 Working in partnership
ESC2 Respecting diversity
ESC3 Practicing ethically
ESC4 Challenging inequality
ESC5 Promoting recovery
ESC6 Identifying people’s needs and strengths
ESC7 Providing service user-centred care
ESC8 Making a difference
ESC9 Promoting safety and positive risk taking
ESC10 Personal development and learning

In psychiatric care, control and self-control are critical aspects of care. The idea of Citizenship remains a historical and current area of practice focus. John Sylvestre of the Centre for Research on Educational and Community Services (CRECS) (https://crecs.uottawa.ca/) suggests in his book, Housing, Citizenship, and Communities for People with Serious Mental Illness, in the chapter entitled, “The contributions of the concept of citizenship to housing practice, policy and research,” that:

1) legal citizenship – individual in a political community,

2)normative citizenship – civic or social organizations, and

3) lived citizenship – daily life, need to be integrated. Lived citizenship has challenges social workers face every day, with focus on the threats to a client’s personal agency and rights within their community. (https://global.oup.com/academic/product/housing-citizenship-andcommunities-for-people-with-serious-mentalillness-9780190265601?cc=ca&lang=en&)

The four aspects of practice outlined: 1) Framework for Support, 2) Social Work Values and Principles, 3) Client Empowerment, and 4) Citizenship are centrally linked to the organizations and systems of governance involved in mental health practice. The social work role in practice and service improvement involves engaging within our organizations and community networks with implementation practices, research, governance and accountability in order to be able to integrate the “bits” of our micro, mezzo, and macro practice.

Bill Dare wrote this article for the Eastern OASW Bulletin’s spring 2018 newsletter focused on the theme of mental health.

Please see other articles on the topic by other eastern branch social workers here: https://www.oasw.org/Public/About_OASW/Eastern_Branch.aspx

“… hints of promising changes to long term care policies..” – the speech from the throne

Pat Armstrong’s analysis with the Canadian Centre for Policy Alternatives explains how we can focus on cracks of opportunity to advance care.

(Image from report: Champlain LHIN report: Planning for Long-Term Care: When care at home is no longer possible)

If not now, when? The throne speech and long term care

… The throne speech also promised “further targeted measures for personal support workers” to “better value their work and their contribution to society.” That could simultaneously address some aspects of systemic discrimination, given that racialized and/or immigrant women disproportionately staff these jobs. It could also help address the shortage of people willing to do the work, as well as help prevent a further she-cession.

Similarly, the throne speech’s promise to implement “a Canada-wide early learning and childcare system” could also support these workers, given that women still bear the primary responsibility for this care. …

See the blog post here: https://behindthenumbers.ca/2020/09/24/if-not-now-when-the-throne-speech-and-long-term-care/

Learn more about Ottawa Local Resources from the Council on Aging of Ottawa : https://coaottawa.ca/committees/health/long-term-care-in-ottawa/

COVID 19 and “the long-standing deficiencies in Canada’s long-term care sector,” Report from the Royal Society

SWAG shared the Royal Society of Canada report.  “The attached document was compiled by some outstanding academics and health care professionals who have been monitoring LTC issues in Canada for decades.  Do take the time to read it and circulate to colleagues in Geriatric care and caregiver support.” 

Overview:  Restoring Trust: COVID-19 and The Future of Long-Term Care

….The report begins by reviewing the research context and policy environment in Canada’s long-term care sector before the arrival of COVID-19.
It summarizes the existing knowledge base for far-sighted and integrated solutions to challenges in the long-term care sector. The report then outlines profound, long-standing deficiencies in the long-term care sector that contributed to the magnitude of the COVID-19 crisis.
Equally important contributors to this crisis are the characteristics of the older adults living in nursing homes, their caregivers and the physical environment of nursing homes.

The long-standing deficiencies in Canada’s long-term care sector and the characteristics of the key players had direct impact on the immediate causes of the COVID-19 crisis in our nursing homes. This report enumerates those immediate causes.

The report then articulates principles for action and recommendations for urgent action.

See the report here: https://rsc-src.ca/en/restoring-trust-covid-19-and-future-long-term-care

Applying Presence in a digital world, “experiences that create the person,” Presentation by Stephen Downes

At a time when “virtual” is landing as a major direction of human care and action, Stephen Downes https://www.downes.ca/ lays out some theory and constuctivist philosophy which I found helpful to wake up, pause and reflect on as clinicians and organizations embrace virtual technology.  The talk is framed for educators, but it got me thinking we are all advancing a form of: “experiences that create the person.”

Being There: What Presence Means in a Digital World

To the extent that learning is a social activity it depends on presence, that is, it depends on the interaction and sense of commonality we have with other people. But presence doesn’t need to be direct and personal; it can be mediated through objects and technologies. An author can speak to us through a book, a friend can speak to us through a telephone, an actor can convey meaning through cinema. But with each medium, the character of presence changes, as some affordances are amplified and others diminished. Which leads us to the question: what is the character of presence in digital media? Unedited Text Transcript (produced by Pixel 4 AI).

See the presentation Here: https://www.downes.ca/presentation/526

“No one walks alone, we walk with you,” the Virtual Art in Strathcona Park

Mental Illness Caregiver’s Association (MICA) bridge art, music, care, creativity to building community.

Virtual Art in Strathcona Park
We at MICA are pleased to present the Virtual Art in Strathcona Park – Virtual Art In The Park. This is our first foray into the virtual world—we see it as a work in progress that will continue to evolve, with your feedback and from visitors to our virtual event.

Over the next 20 days (22 August to 10 September) we will present a showcase of arts and crafts, introduce organizations that offer support and services to caregivers and their loved ones living with mental illness, share information about MICA projects, and offer some light-hearted entertainment at our Caregiver Café.

We invite you to take few moments to tour the website, enjoy the arts and crafts, and learn more about MICA. In addition, would you kindly support our celebration by inviting others you know to visit our virtual event – a flyer is attached to do just that!

In closing, be well and be safe, with our thanks ……

See the website here: https://www.micaontario.com/VAIP/


Help for open clinical discussions on “Covid”

The first resource is a very practical clinical talking script to discuss COVID issues with clients, shared by Simon Landry EENet Connect Co-Manager.  See the explanation by Simon Landry here: https://www.eenetconnect.ca/topic/non-stigmatizing-language-related-to-covid-19

I found it is a rehearsal device for client discussions on COVID.  They call it a “play book”  for COVID and that’s a dammed good title.

What is in this guide?

We’ve crowdsourced this playbook to provide some practical advice on how to talk about some difficult topics related to COVID-19. Building on our experience studying and teaching communication for two decades, we’ve drawn on our networks to crowdsource the challenges and match them with advice from some of the best clinicians we know. If you know our work, you’ll recognize some familiar themes and also find new material.

See the guide here: https://www.vitaltalk.org/guides/covid-19-communication-skills/

This screening scale can help engagement in discussion with people having a hard time talking about it… All.  Here is the the link to eenetconnect post by Rossana Coriandoli of eenetconnect which also includes the scale itself, as pictured below.  https://www.eenetconnect.ca/topic/research-snapshot-new-screening-tool-the-fear-of-covid-19-scale

The novel coronavirus 2019 (COVID-19) has become a significant global challenge. With its extremely high infection rate and relatively high mortality rate, it has caused widespread fear around the world. Previously, researchers showed that fear of COVID-19 leads to considerable psychological and social harms, including stigmatization, discrimination, and feelings of loss.


“Emancipation Day” join this panel discussion on the current work to legislate it in Canada

This webinar event panel on BILL S-255, An Act proclaiming Emancipation Day is organized by Senator Wanda Thomas Bernard and MP Majid Jowhari.

Preamble to the legislation:

Whereas the British Parliament abolished slavery in the British Empire as of August 1, 1834, by enacting An Act for the Abolition of Slavery Throughout the British Colonies; for promoting the Industry of the manumitted Slaves; and for compensating the Persons hitherto entitled to the Services of such Slaves, 3 & 4 Will. IV, c. 73 (U.‍K.‍), on August 28, 1833;
Whereas that Act resulted from the work of abolitionists who struggled against slavery, including Lieutenant Governor John Graves Simcoe, who promoted the passage of an Act restricting slavery in Upper Canada, An Act to Prevent the further Introduction of Slaves and to limit the Term of Contracts for Servitude within this Province, 33 Geo. III, c. 7 (U.‍C.‍), enacted on July 9, 1793;
Whereas Upper Canada was the predecessor of the Province of Ontario;
Whereas abolitionists and others who struggled against slavery, including those who arrived in Ontario by the underground railroad, have celebrated August 1 as Emancipation Day in the past;
Whereas the United Nations General Assembly proclaimed by resolution 68/237, on December 23, 2013, the International Decade for People of African Descent, commencing on January 1, 2015, and ending on December 31, 2024;
Whereas the Government of Canada announced on January 30, 2018, that it would officially recognize the International Decade for People of African Descent;
Whereas the International Decade for People of African Descent provides a unique opportunity to highlight the important contributions that people of African descent have made to Canadian society, and also provides a platform for engaging in the fight against anti-Black racism, discrimination and the inequalities that Canadians of African descent continue to face;
Whereas it is important to recognize the heritage of Canada’s Black communities and the contributions they have made and continue to make to Canada;
Whereas it is also important to recall the ongoing international struggle for human rights as personified by Martin Luther King Jr.‍, Viola Desmond, Rosemary Brown, Marie-Joseph Angélique and Dudley Laws;
And whereas, in consequence, it is appropriate to recognize August 1 formally as Emancipation Day and to observe it as a poignant reminder of an abhorrent period in Canada’s history in order to allow Canadians to reflect upon the imperative to continue to commit to eliminate discrimination in all its forms;
Now, therefore, Her Majesty, by and with the advice and consent of the Senate and House of Commons of Canada, enacts as follows: …

Short Title
Short title
1 This Act may be cited as the Emancipation Day Act.

Emancipation Day
2 Throughout Canada, in each and every year, the first day of August shall be known as “Emancipation Day”.
Not a legal holiday
3 For greater certainty, Emancipation Day is not a legal holiday or a non-juridical day.
Published under authority of the Senate of Canada

Webinar Summary:

During this panel presentation, viewers will have the opportunity to learn from and interact with prominent historians, leaders, and community members about the importance of federal recognition of Emancipation Day. 2020 will be a unique year for Emancipation celebrations, as the 186th anniversary events will be taking place online, offering an opportunity for a wider audience to engage in this conversation about freedom and the on-going movement for racial justice.

Natasha Henry will moderate this panel featuring The Honourable Jean Augustine, Dr. Afua Cooper, Blaine Courtney, Dr. Karolyn Smardz Frost, Irene Moore Davis.


START DATE:7/23/2020



Register here: https://onlinexperiences.com/scripts/Server.nxp?LASCmd=AI%3A4%3BF%3AQS%2110100&ShowUUID=B43F9D94-28E8-4B64-9EFE-547ADE0FBDFD

Contact: https://sencanada.ca/en/senators/bernard-wanda-thomas/

“Police officers carry the name, but don’t monopolize the practice. Policing is structurally integral to all of our institutions, and is carried out both “benevolently” and violently.”

Author Khadijah Kanji in a Rabble blog https://rabble.ca/ The ‘benevolent’ policing of social work and mental health outlines the impacts of racism in mental health and calls on us as a profession to address the fueling of racism.

… As a social worker, I join my critical peers in challenging this assumption. Indeed, our profession comes out of the very same system that has produced the police and, together, we ensure the same thing: the perpetuity of the colonial, white supremacist and capitalist status quo.

We don’t carry guns or tasers, but we do have our own tools and tactics of violence.  …

(image: https://unsplash.com/@yejinghan )

See the article here: https://rabble.ca/blogs/bloggers/views-expressed/2020/07/benevolent-policing-social-work-and-mental-health


SWAG topics in progress for 2020-21 – virtually

Updates from the Social Work in Aging and Gerontology (SWAG) Ottawa steering committee: Colleen Barclay, Catherine Bennett, Wendy Birkhan, Karen Anne Blakely, Carmelina Cimaglia, Joanne Green, Beverlee McIntosh, Bonnie Schroeder.

Mark your calendars for the upcoming year of education and networking  opportunities.
Thetopics and dates below are tentative as speakers may change due to unforeseen circumstances or we may have to switch a date to accommodate a particular speaker.  More details of each monthly topic will be sent closer to the date via the email distribution list or through the SWAG Facebook page @SWAGOttawa .

All presentations for the 2020-2021 year are to be done virtually. We still plan to hold the SWAG meetings at 3:30 to 5PM.  In order to maintain SWAG’s undertaking to provide a safe place for social workers to discuss issues in their area of practice, the “Update & Go-around” (15:30 – 16:00) shall not be recorded. If things change, and we can go back to meeting in person, we will update you.

As always SWAG participation is limited to social workers and social service workers, students or people working in a social work-type position within our network. Online registration is not open to the general public. We plan to record the 1 hour presentations so that interested social workers across Ontario may access the information on the OASW web site.


Thursday September  24 De-prescribing/Medical Reduction
Thursday October  22 Covid-19 seniors survey – Ottawa Council on Aging
Thursday November 19 Home Takeovers  defrauding seniors  – Ottawa Crime Prevention
Thursday January 21 Hospital Geriatric Emergency Management accommodating seniors
Thursday February18 Racial diversity and seniors in the community
Thursday March 25 Homebound Ottawa Library Services
Thursday April  22 Cannabis use and benefits for seniors
Thursday May 20  Police training for interventions with elderly victims or elderly offenders

Learn more: https://www.facebook.com/SWAGOttawa/



Talking about the impact of racism in our everyday practice “Racism in Health Care” (11:30 am, Thursday July 2/20)

Susan Obiorah’s experience as a care manager at one of the local community health centres and her work with the Royal’s  – Pathways to Better Care – system change efforts will sharpen the focus on how racism is manifested in care.  This event is organized by the Ottawa Hospital.

Our Healthy Conversations series continues this week, as we discuss racism in various areas of health care, including hospitals and community health-care settings.

Tune in LIVE on Facebook this Thursday, July 2 at 11:30 am as Suzanne Obiorah discusses her experiences of racism, and how it can impact community health care.

Stay tuned for more information and upcoming sessions!

Here is the recorded talk: https://www.facebook.com/OttawaHospital/videos/274839013730694/